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Use this form to sign up as a racer at the Cullman Derby Days race!
Race Day is Sunday, July 13th. SIGN UP DEADLINE is June 30th. You will NOT be able register on race day.
Fill out this application form to register for the Derby Day. We have decided to waive registration fees this year because of a generous donation.
Entrants under 18 must be accompanied by a responsible adult. It is incumbent upon the racers to have read and abide by all race and vehicle requirements.
Racers will be sent a waiver prior to the race. This must be signed an returned to check in.
Full Name*
Street Address
City/Town
Zipcode
Contact Phone Number
Email*
Age on July 13th 2025*
If under 18- name of parent
Car Name
Preferred Racer Number
Additional Notes*
Your Wednesday Color*
Submit Form
Please review what you entered before you click the Submit button, and click it ONLY ONCE.
