Official Florida Wiener Dog Derby

            RACING UNDER THE LIGHTS
                   REGISTRATION FORM

                         July 10, 2010 

Name_______________________________________________

Address_____________________________________________

City____________________________State____Zip__________

Phone (____) ____________E-mail________________________

Name of Dog__________________________________________

Age of Dog______________

$5.00 entry fee for this exhibition race

Please submit a copy of current shot records with registration form.

 Dachshund Breed Only...Shot records must indicate dog is of a Dachshund breed

This is an exhibition racing event held in conjuction with the Fort Myers Miracle 
Baseball Organization. Ticket must be purchased for Fort Myers Miracle game in
order to participate in this event.          

THIS IS A RAIN OR SHINE EVENT 

Mail entry form along with check or money order and current shot records to:                      

        Florida Wiener Dog Derby Inc.
        4085 Hancock Bridge Parkway

        Suite 111   Box 303

        North Fort Myers, Florida 33903

 EACH DOG REGISTERED MUST BE ON A SEPERATE REGISTARTION FORM.
 DUE TO TIME CONSTRAINTS, EACH DOG MUST HAVE ONE HANDLER.