2025 Frostburg Elks Derby
Day Sponsor Registration: Deadline is June 1, 2025
Sponsor Information
Business/Organization Name: ________________________________________________
Contact Name: _____________________________________________________________
Mailing Address: ____________________________________________________________
Contact phone Number: ____________________________________________________
Contact E-mail Address: _____________________________________________________
Car Information
Do you have a derby car? ☐ yes ☐ No Car Number: _______________
Driver Information
Do you have a driver? ☐ yes ☐ No
Driver’s Name: ______________________________________________________________
(Must fill out Driver Registration Form)
Fees
__________ Car Sponsorship $180
__________ Program Ad $100 Full Page, $50 Half Page
(Must send a new ad in PDF or JEP form to scott_race@comcast.net)
__________ Sponsor Logo on Driver’s Shirts $50
__________ Photo Package $25
__________ Total
Please check here is you want a copy of the Derby Day Program ☐
Legal Stuff
All fees must be paid before the car and/or driver participates in any Derby Day activity. Sponsorship does not imply ownership of any derby car. I release the Frostburg Elks Lodge #470, its membership, sponsors, the Frostburg City government, and any other agency or person aiding Frostburg Elks Lodge #470 from all liability relating to any activity associated with Derby Day.
The driver/car must complete an inspection and 2 trial runs.
The driver and their Pit Chief must attend a safety/information session. The driver must weigh-in and have their photo taken.
By signing this form, I certify that all information is true and accurate and that the legal terms have been accepted.
Printed Name: ________________________________________ Signature: _______________________________________
Date: ______________________
Return form to:
Frostburg Elks Lodge #470 Attn: Derby Day
126 East Main Street Frostburg, Maryland 21532
*Send ads in PDF or JPEG form to scott_race@comcast.net
Contacts:
Jim Meyers 240-580-0968 Sharon Kyle 240-362-8029