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:____________________________
Driver of Record______________________
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
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
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_____