SEMA Derby

Thank you for your interest in the SEMA CARES Pinewood Race sponsored by Fellers and Dub Publishing. Please complete the form below to reserve your space. A charity representative will follow-up regarding payment and rules. The race will be held prior to the SEMA Installation Banquet and Gala Fundraiser July 25, 2008. Tech inspection begins at 1:30 pm, races begin at 3:00 pm.

All proceeds from the event will benefit Childhelp USA and Victory Junction Gang Camp.

First Name

Last Name

Company Name

Street Address

City

State

Postal Code

Phone

Email Address

THE EVENT INCLUDES THREE VEHICLE CLASSES - WHAT VEHICLE CLASS ARE YOU REGISTERING FOR? (click on blue "?" box for class descriptions). We also have an additional opportunity for donors who don't have the time to build a vehicle "BUILD IT FOR ME/SPONSOR A CHILD".

STOCK - donation $125

MODIFIED - donation $150

UNLIMITED - donation $200

BUILD IT FOR ME/SPONSOR A CHILD - DONATION $125

Some participants (particularly in the modified classes) have requested additional kits for test purposes. Would you like additional kits (each kit is $20.00 each).

no thanks, I'll get it right the first time!

one additional kit

two additional kits

three additional kits

Some participants will be building a vehicle, but unable to attend the actual event. If you are unable to attend, would you like us to assign a "driver" for you?

Yes, I am planning to attend the race.

No, I am not planning to attend, please assign a "driver".

By checking this box I agree to the terms described in the official rules and regulations (click on blue "?" box for full rules and regulations) and I promise to have a ton of fun with this event!

Yes, I agree to the rules and regulations and promise to have a ton of fun at the event!

For questions regarding your entry, please contact mspagnola@streetsceneeq.com

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