Entry Form
The cost is $40.00 for each class per race entered.
Annual UMPBA membership dues are required to race$35.00.
DUE to limited allotted time at the Fairmont race ALL racers must preregister by Friday the 13th of August 2010.
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Pre-Registration Form
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First Name: _______________
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Last Name: ___________________
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Address: _______________________________
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City:
_____________________
Phone:__________________ (Home / Work / Cell) Driver's Age:_________
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State/Province:_____________
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Zip/Postal: ____________
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Email Address: (not sold or shared)_____________________________________________
Emergency Contact Person: __________________________________________________
Relationship:_______________________
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Phone: __________________________ _
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REGISTRATION
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Year of Boat: __________
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Length of Boat: ________
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Type of Boat: ___________________________ _
Engine Type & H.P.
_____________________
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SELECT
THE CLASS YOU'LL BE RACING IN (circle one)
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[] LAKE RACER 3 86 - 95 mph
[] UNLIMITED 96 mph and faster |
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In
an attempt to add to the event, we are encouraging announcers to share "color
commentary" on our racers, their boats, families & anything that adds interest.
Please
help us by including anything you would be willing to share
towards that goal:
Material to be shared on Race-Day by the
announcing staff:
Approximate distance you traveled /will travel to get to Fairmont, Mn.? Miles ?
Where do you live? City /
Town: State of _________________________________________ _
What do you do for a living? ___________________________________________________ _
Family? ___________________________________________________________________ _
Any Children? ______________________________________________________________ _
How many boats do you own? _____________________________________________
Ever raced boats professionally? Yes I No
What are
your primary hobbies? ________________________________________________ _
Describe your boat / engine /
prop / rig? ____________________________________________ _
Why didyou decide to come to the Fairmont
Race________________________________
Other descriptions or information for the Announcer:______________________________
Date
registered:_________
Liability release form signed by driver? Y / N
Registration paid by driver Y / N
Registration Number Assigned:______
REGISTRATION # ________
In consideration of their promotional efforts on behalf of the sport, I
hereby assign all commercial communication and broadcast rights to the
Upper Midwest Power Boat Association, Inc. and do declare them as my
lawful agents’ and representatives regarding such rights.
I, the undersigned participating in events sanctioned by the UMPBA,
agree that UMPBA and its assigns may use my name and picture and
pictures of my race boat, or any of them, in any way, medium, or
material for promoting, advertising, recording or reporting any UMPBA
sanctioned event before, during and after such event and do hereby
relinquish all rights hereto for these purposes.
Signed ________________________________________ Dated ___________
Please mail completed form along with your payment to:
The Upper Midwest Power Boat Association
61456 County Road 21
New Ulm, MN 56073