AGASSIZ SPEEDWAY Presents the 2nd Annual
JIM DARBY MEMORIAL 2007

Name_________________________________
Address_____________________________________________
Postal Code__________________
Phone #_____________________
E-Mail:______________________
Drivers License #______________
Medical #____________________

Do you have any Medical Conditions you would like us to be aware of?
IE: Diabetes, Epilepsy
____________________________________________________
_____________________________________________________________________

About you and your car:
Make & Model____________________________Car #_______
Sponsors:__________________________________________________________
__________________________________________________________________
__________________________________________________________________
Highlights:__________________________________________________________
__________________________________________________________________
__________________________________________________________________
Home Track:_________________________________

Pre-registration: $75.00 (MUST be received prior to race day) At the Gate: $100.00
Please complete this form and mail to: Agassiz Speedway, P.O. Box 9, Agassiz, B.C.
Please include your registration fee. ***Make checks payable to KENT RACEWAYS