Driver of Record:
Name:_____________________________ DOB:__,__,____ Age:___ Phone:__________
Address:_________________________________________________Allergies________
Email:___________________________, Signature:____________________________
Co-Driver:
Name:_____________________________ DOB:__,__,____ Age:___ Phone:__________
Address:_________________________________________________Allergies___________
Email:___________________________, Signature:____________________________
Co-Driver:
Name:_____________________________ DOB:__,__,____ Age:___ Phone:__________
Address:__________________________________________________Allergies___________
Email:___________________________, Signature:____________________________
Name:_____________________________ DOB:__,__,____ Age:___ Phone:__________
Address:_________________________________________________Allergies________
Email:___________________________, Signature:____________________________
Co-Driver:
Name:_____________________________ DOB:__,__,____ Age:___ Phone:__________
Address:_________________________________________________Allergies___________
Email:___________________________, Signature:____________________________
Co-Driver:
Name:_____________________________ DOB:__,__,____ Age:___ Phone:__________
Address:__________________________________________________Allergies___________
Email:___________________________, Signature:____________________________
Driver of Record______________________
Race Vehicle #____________
Class Entry____________
Race Vehicle #____________
Class Entry____________
Entry Fees:
Pro Entry Fee = 350.00
before 8/21/10 300.00 _________
Sportsman Fee: 225.00
Before 8/21/10: 175.00 ________
EDR Membership: 30:00 ________
(Must be member to race)
Total payed: ______
Cash only at Tec-Reg
Make checks payable to Extreme Desert Racing
P.O. Box 91615 Austin, Tx 78709, due by 8/21/10
No Checks at Track, Cash only
Recieved:___________ Ref#____________________
60-30-10 payback
Pro Entry Fee = 350.00
before 8/21/10 300.00 _________
Sportsman Fee: 225.00
Before 8/21/10: 175.00 ________
EDR Membership: 30:00 ________
(Must be member to race)
Total payed: ______
Cash only at Tec-Reg
Make checks payable to Extreme Desert Racing
P.O. Box 91615 Austin, Tx 78709, due by 8/21/10
No Checks at Track, Cash only
Recieved:___________ Ref#____________________
60-30-10 payback
Extreme Desert Racing LLC. John Clark,512-848-4344 fax 512-687-5310/ Email: John@Texasoff-road.com
Registration & Tec Form
I understand that EDR Reserves the right to Refuse any Vehicle or Persons from entering the
race for any reason. A full refund will be returned if vehicle or persons have not entered Event.
I also acknowledge to the best of my ability, that my vehicle is in good condition to race. I assume
all responsibility of my actions with my vehicle and hold Harmless any part of the EDR,Extreme
Desert Racing LLC. organization. I also agree to follow all rules and regulations set forth at each
event.
_____________________________, __________, ____________________________
Driver Signature date Print Name
race for any reason. A full refund will be returned if vehicle or persons have not entered Event.
I also acknowledge to the best of my ability, that my vehicle is in good condition to race. I assume
all responsibility of my actions with my vehicle and hold Harmless any part of the EDR,Extreme
Desert Racing LLC. organization. I also agree to follow all rules and regulations set forth at each
event.
_____________________________, __________, ____________________________
Driver Signature date Print Name
| Texana Night Race 180 Sept 3rd,4th,5th |
REQUIRED TO RACE /Pre Run
Helmets ____ Snell, DOT
Seat Belts ____4,5point(*3point)
Race suits ____SFI labeled
Window nets ____ both sides
Roll Cage ____full Cage
First Aid Kit ____
Tow Strap _____
Fire Extinguisher _____3 lbs
(Trophy trucks Fire Suppressant)__
Amber light_____1 (yellow) 4" or better
Brake lights ____ 1(Red) 4" or better
Secure Battery _____ ( Dry, gel Cell)
Fuel Cell ____ inside caged area
Reflective Strips ____ rear,both doors
(12" by 2"), Red/Silver
Reflective Square____ Rear of all Helmets
( 2" by 2" ), Red
2 Reflective Triangles ______
GPS Navigator Model ________
Muffler / Spark Arrestor _______
Racer Initials____
Tec official_____
Helmets ____ Snell, DOT
Seat Belts ____4,5point(*3point)
Race suits ____SFI labeled
Window nets ____ both sides
Roll Cage ____full Cage
First Aid Kit ____
Tow Strap _____
Fire Extinguisher _____3 lbs
(Trophy trucks Fire Suppressant)__
Amber light_____1 (yellow) 4" or better
Brake lights ____ 1(Red) 4" or better
Secure Battery _____ ( Dry, gel Cell)
Fuel Cell ____ inside caged area
Reflective Strips ____ rear,both doors
(12" by 2"), Red/Silver
Reflective Square____ Rear of all Helmets
( 2" by 2" ), Red
2 Reflective Triangles ______
GPS Navigator Model ________
Muffler / Spark Arrestor _______
Racer Initials____
Tec official_____