Application for the First Annual

Ballston Spa Rolling Roadster's Race

To be held on August 12, 2000

(raindate August 13, 2000)

 

Name:___________________________________

Age: _____________

Address: _________________________________

Telephone Number: _________________________

Signature of Supervising Adult _________________

Emergency Contact (other than Supervising Adult)

Name: _________________________________

Address: ________________________________

Telephone Number: ___________________________

This application, the signed waivers and a five dollar ($5.00) day of race refundable fee must be received at Ballston Spa Village Offices, by close of business, July 21, 2000, 4:00 pm.

 

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