ENTRY FORM
                                                                  TENNESSEE SLAMMERS BANGERS
APPALACHIAN FAIR 
August 24, 2012 - 4-6 cyl cars, $10.00 per vehicle entry fee 

 
APPALACHIAN FAIR 
August 25, 2012 - 1980 or newer stock demo derby cars, $10.00 per vehicle entry fee

All pit passes are $10.00, driver and any one entering pits needs pit pass.   
     
 
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I need to buy a car # ___________________For $15.00 
I would like car # _______1st ________2nd________3rd 
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Name:________________________________________________________ 
Address:______________________________________________________ 
City/ Zip:______________________________________________________ 
Phone:_______________________________________________________ 
Social Security Number:_________________________________________ 
 
Please make all checks payable to John Brown, and mail to 130 John Brown Lane, Fall Branch
Tennessee 37656 you can contact John at 423-534-9563 
If your check is returned by your bank for any reason you will lose your entry and you will be
required to pay additional $30.00 fee plus original entry fee for re- entry.  
Please mark the event you wish to attend in the boxes next to the dates and event center. 
I have read the rules and regulations and understand them and by signing this form I agree to the
rules and regulations and will comply with all of them. 
Signature:____________________________________________Date:___________________________________