Mail to:   

Jack Fullerton

286 GLADE CITY ROAD           

MEYERSDALE, PA15552

Mail Entry By: August 10th                                      

Telephone:  

814-634-0916

MUD BOG - SOMERSET CO. FAIR

Name:

Address:

City: State: Zip:

Age   Date of Birth

Phone Class

Engine Size Horse power # of Cylinder Tire Height

Name of Vehicle (if any)

I have read the rules and accept the decision of the Judges as final. I elect to use the grounds or track in it's present condition.

Date_____________ Signature______________________________________

 Designed by Dylan Murray