Print & Mail Registration Form

Woodbooger Demolition Derby
Lebanon County Fair
Mack Road
Lebanon, CT
August 8, 2010
4:00 PM

Name____________________________________________

Address__________________________________________

City_______________________State__________ZIP_____

Phone___________________________________________

E-mail Address___________________________________

Number of cars entered:4cyl_____ 6cyl_____ 8 cyl _______

Figure 8:___________

Car Number(s) ________________

Please mail your $75.00 entry fee, Money Order or Bank Check (No Personal Checks)

to:

Eileen Mann
283 Broadway
Taunton, MA 02780

If you have any questions please call Jim (508)577-6850
Jim or Eileen at (508)880-8941