Name__________________________________________ Address _________________________City_____________ Phone #_____________or Cell#______________________ Vehicle Year Make & Model___________________________ Name or Sponsors you want to mention__________________ _______________________________________________ Do you give us permission to take pictures and put them on face book and our web page Yes _____ or NO ______ If under 18 must have signed permission slip from parent or guardian YES_____ Liability Waiver must be signed YES_____
1A.) 33 & under street stock____________________ 1.)33 to 36” DOT ___________________________ 2.) 37 to 40” DOT____________________________ 3.)40.5-44” DOT ____________________________ 4.)Modified ________________________________ 5.)Open ___________________________________
Pre-Entry fee $20.00 per class, Day of Entries $30.00 per class Mail to P.I. Mud Bog P.O. Box 165 Millersburg, Mi. 49759
Pit Time#1__________ Time #2 __________ Distance #1_________ Time #1 ___________ Distance #2 ________ Time #2 ___________
Points for placing 1st = 15 pts 2nd =10 pts 3rd = 5 pts Points for entering 2pts
Liability Waiver & Release of Indemnity Agreement Mud Bog at Presque Isle County Fairgrounds in Millersburg
In Consideration of being permitted to enter for any purpose and Restricted Area (herein defined as the areas to which admission by general public spectators is prohibited) or being permitted to complete, officiate, observe, work for, or for any purpose participate in any way in the event. EACH OF THE UNDERSIGNED, for himself, his personal representatives, heir, and next of kin, acknowledges, agrees and represents that he has or will immediately upon entering any of such restricted areas, and will continuously thereafter, inspect such restricted areas and all portions thereof which he enters and with which he comes in contract, and does further warrant that his entry upon such restricted area or areas and his participation, if any, in the event constitutes and acknowledgement that he has inspected such restricted areas and that if, at any time, he is in or about restricted area. 1.)HERBY RELEASE,WAIVES, DISCHARGES AND CONENANTS NOT TO SUE the promoters, other participants, operators, officials, and any persons in any restricted area, sponsors, advertisers, owners and lessees of premises used to conduct the event and each of them, their officers and employees, all for the purpose herin referred to as “releases”, from all liability to the undersigned his personal representatives, assigns, heirs and next of kin for any and all loss or damage, and any claim or demands there to on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releases or otherwise while the undersigned is in or upon the restricted area and/or competing, officiating in, observing, working for, or for any purpose participating in the event. 2.) HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in or upon the restricted area or in any way competing, officiating, observing, or working for, or for any purpose participating in the event and w whether caused by the negligence of the releases or otherwise. 3.)HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releases or otherwise while in or upon the restricted area and/or while competing, officiating, observing, or working for or for any purpose participating in the event. EACH OF THE UNDERSIGNED expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by law of the Province or Stat in which the event is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in the full legal force and effect.
THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABLILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representation, statement or inducements apart from the foregoing written agreement have been made.
MILLERSBURG MUD BOG RULES Class 1A Ø STREET STOCK up to 33” DOT tires Ø FACTORY EQUIPMENT FOR THAT YEAR Ø Must be street legal. Plates not required Ø Complete exhaust system Ø Secure hitch with ¾” pin clevis at rear Ø Must have seatbelt and helmet (fire extinguisher recommended) Class 1 Ø Tire size 33-36.5” DOT Ø 4x4 vehicles only- production type frames and suspension Ø Any motor drive train combination Ø Front of motor cannot be behind center line of front axle Ø Body swap and flat beds are allowed Ø Secure hitch with ¾” pin clevis at the rear Ø Single carb, gasoline only Ø No nitrous Ø No aluminum heads or aluminum blocks permitted Ø Must have seatbelt and helmet (fire extinguisher recommended) Class 2 Ø Tire size 37-40”DOT Ø Rules same as Class 1 with this addition change: dual carb allowed Class 3 Ø Tire size 40.5-44” DOT Ø Rules same as Class 1 & 2 with these changes: aluminum heads allowed Ø Chain drive ok Ø Front of engine block must be within 6” of center of front axle Class 4 Modified Ø Up to 44” DOT tires and cuts allowed Ø Tube chassis allowed Ø Engine, carburetion, and chassis modifications allowed Ø Any type of suspension Ø Duel carb or fuel injection Ø or support removed must have 4 point roll cage and 4 point harness to frame Ø Secure hitch with ¾” pin clevis at rear Ø Must have seatbelt and helmet (fire extinguisher recommended) Class 5 Open Ø Anything safe goes Ø Same rules as Class 4 with these changes: any type of chassis or body Ø Alcohol and nitrous allowed Ø All tractor tires 44” and larger tires allowed Paddle tires and blowers allowed 0 Paddle tires and blowers allowed