Championship Mud Racing

CANADIAN CHAMPIONSHIP MUD RACING

2017 RACE SEASON

OFFICIAL SERIES APPLICATION

Season Registration $100

Class Registration is $30.00 for the first class.

EachAdditional Class Registration $20.00

MUD CROSS Classes:

______Bogger Class451 to 750+cc Make/Model______

Single Cylinder only

______Pro A Class500 to 1000+cc Make/Model______

Less than 53 inch wheelbase

______Pro B Class500 to 1000+cc Make/Model______

More than 53 inch wheelbase

______Super Modified Class 0 to1000+ccMake/Model______

______RUV Class 0 to1000+ccMake/Model______

______Women’s Class 0 to 1000+ccMake/Model______

“STOCK” Class

______“STOCK” A 0 – 80 0cc Make/Model______

______“STOCK” B 800 – 1000 cc Make/Model______

Mud Bog Youth Classes

______Youth Class 1 Single Cylinder0–125 cc Make/Model ______

______Youth Class 2 251–450 cc Make/Model ______

______Youth Class 3 300-500 cc Make/Model ______

______Total # of Classes

______Total Amount Due

*No refunds will be given if rider registers, but fails to compete in the series events.*

The undersigned rider/entrant agrees to abide by all CCMR rules, regulations, and decisions. This entry will not be accepted until all fees are received and processed and CCMR Headquarters approves the entry.

RIDER INFORMATION

First Name: ______Last Name: ______

Telephone: ______Fax: ______

Mailing Address:______

City: ______State ______Zip ______

DOB: ______

*(Driver must be over the age of 4 years old in order to race in youth, and the age 16 in order to race in adult classes – NO EXECPTIONS will be made. Proof of birth certificate will be required. If under 18, please obtain and sign a minor’s release form)

Driver License # ______State ______Exp. Date ______

Emergency Contact Number: (____) ______

RELEASE FOR RE-USE OF NAME, ETC

In consideration of the awards of this event(s), the acceptance of this Entry by CCMR, the vehicle owner and rider individually and jointly, agree and consent, that CCMR, Promoter, and the assigns of either or both, may use their name(s), picture(s), likeness(es) or performance(s), of any them, in any way, medium or material for promoting, advertising, recording or reporting this event(s) before, during and after such event(s) including but not limited to television and radio broadcasts, film productions, video tape productions, video game productions and the like (“The Rights”), and do hereby relinquish all rights to CCMR, Promoter, and the assigns for either or both for sales and other commercial projects.

Signature ______

Please send check or money order to the address below.

Canadian Championship Mud Racing Headquarters

Site 303 COMP22 RR3

Onoway, AB T0E 1V0

Bill Ford Cell: 780-271-9868 e-mail: