MOTTVILLE SPEEDWAY 2004 Registration Form   $20

Circle:  STREET STOCK       MINI THUNDER CAR            MINI STOCK                  KART     BOMBER         OPEN COMP

Number Requested 1st Choice_______    2nd Choice________3rd Choice _______

Driver Name:________________________________________ Phone:____________ Soc Sec #________________________            

 Mailing Address : City                                  ____________________________State                ZIP_____________                                                   

 Driver Date of Birth:_____________  Years Racing Experience:                                                   

Who is responsible for earnings (IRS 1099 Form)? ______________________ 

If not the driver fill in Social Security  # of person responsible:____________________

Mailing Address:  City:                                        __________State                 ZIP                

IF YOU WANT SPONSORS ANNOUNCED YOU MUST CLEARLY PRINT THE INFORMATION ON A 3 by 5 INDEX CARD WITH THE DRIVER NAME, DIVISION AND CAR # AT THE TOP.  

·         I fully agree to abide by the rules and regulations of the Mottville Speedway. I acknowledge that I have received a copy of the rules and I fully understand that all decisions of track officials are final!

·         I understand, accept and agree that no ambulance or medical staff is on site.

·         I accept emergency equipment and staff as adequate.

·         I fully understand that I am racing at my own risk.

·         I understand that if I am disqualified for rough driving, unsportsmanlike conduct, an illegal car, drinking in the pits, speeding in the pits or any other form of disqualification that I will be paid nothing for the night!

·         I fully understand that the TIMING TOWER is off limits to all drivers, crew member, car owners during the racing program and that if I go to the timing tower I will suspended and/or fined as determined by track officials. I understand stock cars must finish feature to be paid.

·         I understand the tire and weight rule for my division and I understand that this registration can’t be transferred to another division without an additional payment and cannot be sold.

·         I understand that that if I leave any used tires on track property the fine is $10 per tire and I agree to pay it!

·         I fully understand that racing is by its very nature a very dangerous sport and I agree to hold totally blameless the Mottville Speedway, its owners and track officials for any and all injuries suffered by me.

·         In the event of my death I direct my estate to take no legal action against the Mottville Speedway, its owners or track officials.

·         I understand that if I do not race at the Mottville Speedway for a period of 3 Weeks my number will no longer be reserved. Any car left at the Mottville Speedway 2 weeks without racing will be disposed of with a $35 fee!

I HAVE READ AND I FULLY UNDERSTAND THIS AGREEMENT AND AGREE TO ABIDE BY IT!

 Driver Signature:____________________________________________Date:__________Print Name                                           _____           

Car Owner Signature:_________________________________________ Date:_____________Print Name:_______________________          

If driver is under 18 years of age I, the parent or legal guardian of the driver, by signing below agree that I have read the above agreement and will abide by it and that I have signed the MINOR RELEASE AGREEMENT for the season and that I assume all responsibility for any and all injuries suffered by the above named minor. I fully understand that track does not promote the driving of race cars/karts by minors but will allow it based on my assumption of the risk.

Parent/Legal Guardian Signature:___________________________________ Date:_____________ Print Name:___________________