Registration Form

Okie Derby Rally Fee - $55 / Airplane*

Pilots Full Name*

Address

Street Address City State Zip Code

Cell Phone*

Email*

Co-Pilots Name

Phone

AIRCRAFT

I am entering the following aircraft in the OKIE DERBY.

N#

Aircraft Make

Model

Year

Color(s)

Is your aircraft equipped with a FUEL MONITOR?

Yes

No

Predicted Ground Speed in Knots

* This is your proficiency speed handicap. Pilots must indicate the speed they want to utilize for their handicap for an entry to be accepted. This is the ground speed that must be averaged over the entire course. If this is your first Okie Derby, please refer to the First Time Rally Tips posted on www.okiederby.com or request your copy through registration for guidance. Any changes to your ground speed prior to the rally must be approved by the Okie Derby Board Chairman/Vice Chairman.

Total Logged Hours*

If flight school or college, specify below:

If you have flown the Okie Derby previously, indicate the number of years.

OKIE DERBY DINNER & AWARDS BANQUET

Number of Adults

Number of Children

Pilots Name*

Digital Signature (Please put your initials)*

CERTIFICATE OF INSURANCEA certificate of insurance is required.Certificate of Insurance (pdf) Have this form completed by the insurance company which covers the aircraft you plan to use in the flying event.

Today's Date*

The closing date for entries is August 14, 2023 and all paperwork, including the certificate of insurance must be received no later than August 19, 2023.

By checking the box below, I hereby certify that I will adhere to the OKIE DERBY Rules and Regulations, as published by the Oklahoma Chapter of the Ninety-Nines. I certify that I will accept the decision of the judges as final.

I Agree to Terms & Conditions*

I Agree to Terms & Conditions

*** After submitting this application, please make your online payment in the next step ***

2023 Okie Derby Registration