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July 22, 23, 24, 25, 26
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PLEASE PRINT ****************************************************************************************************
REGISTRATION FORM - MUST BE IN NO LATER THAN 1:00 P.M. JUNE 15, 2011 for the JUNE 18 RACE , 1:00 P.M. JULY 25, 2011 for the JULY 27 RACE .
Name of Driver________________________________
Phone Number_______________________
Make and Model of Car_____________________
Age of Driver_______Male_____Female____Car number assignment ____________
Entry fee paid by: Cash_______ Check____________ Registration for JUNE 18 RACE___________________ Remit $10.00
Registration for JULY 27 RACE ___________________ Remit $10.00
Please check which race you are entering. Total Enclosed_______________________
Address____________________________
City________________________________
State_______________Zip_____________ Return to: Peggy Groves Lyon Co. Fair Assn. 1206 Buchanan Ave Larchwood, IA 51241
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WOMEN ON WHEELS ENTRY
Name _____________________________________________
Address____________________________________________
City_______________________________________________
State ______________________Zip_____________________
Age______________________
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