2008 Combine Derby Entry Form

Entry Fee $25.00.  The Driver and 2 crew members will be admitted free at the gate when they come through with the combine additional ”pit passes” will be available for $20 each.  Combine number must be painted on both sides and near the top of the combine.  The driver must be at least l8 years of age. Entry eligibility is limited to the first 20 entries from Porter or adjoining counties.

Participants are required to sign a RELEASE AND CONSENT FORM prior to the contest. 

Date of Event – Wednesday, July 23, 2008

Entrants Name_____________________________________________________Age___

Address_________________________________________________________________

Phone____-____-________            Combine Number____________

Clip and Mail the release form/entry form to:

Dennis Steinhilber, 476 S. St. Rd. 2, Hebron, In 46341

I, the undersigned, have read the official rules and entry above, and hereby agree to abide by and adhere to all such provisions as outlined and/or as further instructed by derby officials.  I agree to hold harmless from the liability the Porter County Ag. Society, Inc. and it’s agents as well as other participating contestants in the event of accident or injury.

Signature of the Driver______________________________Date_______________