TRAIL-WAY SPEEDWAY & STARLITE CLUB
2012 Reserved Number Form
*IMPORTANT !! - ALL DRIVERS THAT RETURN THIS FORM COMPLETED BEFORE THEIR FIRST
SCHEDULED RACE, WILL BE ELIGIBLE TO DRAW A SECOND PILL FOR THEIR INITIAL LINE
UP.*
1.
All Race Drivers are required to reserve their racing number when entering
any of the Starlite classes for the first time during the racing season. This
number is reserved for the individual driver, not the car.
2.
Those drivers that wish to retain their previous
years number, must complete this application, sign the release form below
and send the required fee no later than December 31 in order to reserve
your number for the next season, or that number may be available for other
drivers to use. Minors under 18 must have form notarized below.
3. Racing numbers: must
have (4) locations on each race car; (1) on each side of the front doors,
(1) on lower face of the rear trunk lid in small numbers above the bumper,
so the number is visible to the car driver behind and (1) number must be on
the roof. Scramble Cars must have roof plate. No
Reflective Lettering or Profanity allowed.
4. (2) digit numbers and can not be less than
11" high 7" wide black on white.Must be vinyl or painted according
to size and color. No reflective lettering or profanity allowed.
5. All drivers must fill out a data card completely,
(including year & make of car)
on their first visit to Trail-way. Due to the increased costs associated
with providing a quality race facility, the Saturday night divisions will
pay a $10.00 per car sign-up fee each week per class & $20.00 per car
for each additional class.
A) $30.00 will cover cost of Starlite membership
($15.00) and first class for TW reserved number form ($15.00), a savings of
$10.00. Additional classes will only be a cost of $15.00 to TW.
*Starlite Friday Night Limited Stock* Starlite Saturday Night Limited Stock
* Starlite Scramble Cars* Starlite Strictly Stock *
PLEASE SEND IN PAGES 2 AND 3. YOU ONLY NEED TO SEND IN PAGE 4 IF YOU ARE UNDER 18 YEARS OLD.
EXAMPLE, I WOULD LIKE TO RESERVE CAR NUMBER __99___IN CLASS_Starlite Strictly Stock__:
#_______ 1ST CLASS ___________, #_______ 2ND CLASS ___________,#_____ 3RD CLASS __________
1. CHECK BOX TO ACKNOWLEDGE THAT I WILL READ THE 2012 RULES and MUST BE PRESENT AT THE BANQUET TO RECEIVE ANY YEAR END AWARD.
2. CHECK BOX IF YOU ALREADY OWN A RACECEIVER.
TO RETAIN PREVIOUS
YEAR RACE CAR NUMBER, EACH RESERVED NUMBER MUST
BE APPROVED AND PAID FOR AT THE SPEEDWAY OFFICE BY DECEMBER
31, 2011.
Any driver under the age of 18 must have form signed by parent and notarized!
Forms not completed in full will be returned to you un-processed! Email
Address is VERY Important
2. DRIVER NAME__________________________SS #__________________PHONE_______________
ADDRESS___________________________________________________AGE___________________
CITY______________________________STATE__________
ZIP CODE_________________
5. E-MAIL ______________________________@_________________________________
PERSON RESPONSIBLE FOR RECEIVING RACE WINNINGS
(EVERYONE RECEIVING OVER $600 WILL RECEIVE A 1099 FORM)
4. RECEIVER'S NAME_________________________________________PHONE_______________
ADDRESS__________________________________________________________________________
CITY____________________________________________STATE________ZIP CODE_________
5. E-MAIL ______________________________@_________________________________
SOCIAL SECURITY
# OR TAX ID # OF PERSON RESPONSIBLE
>>>FOR TAXES____________________________
LIST 1 MAIN SPONSOR
1. ____________________________________TOWN/STATE/ZIP_______________________________
Office Use Only: Rec. Date_______/_______ Cash or Ck#________ Int _________
Other Info ___________________________________ Sent Date ____/____
RELEASE FORM, MUST BE SIGNED
(A) This Is A RACE LIABILITY RELEASE For Applicant
Named On Reverse Side Of This Form
(B) PLEASE READ THE FOLLOWING AND COMPLETE ALL NUMBERS.
(C) Complete 1 through 3 when applicant is OVER 18
years of age.
(D) Complete 1 through 7 when applicant is UNDER
18 years of age.
In consideration of being granted
an opportunity to race at any or all races sponsored by TRAIL-WAY SPORTS CLUB,
INC. DBA/ MOTORAMA EVENTS, AND/OR TRAIL-WAY SPEEDWAY, I intend to be
legally bound hereby:
I, for myself, my heirs, personal
representatives and assigns, HEREBY RELEASE , DISCHARGE AND AGREE TO HOLD
HARMLESS AND INDEMNIFY TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA ASSOCIATES
AND/OR TRAIL-WAY SPEEDWAY, the promoters, property owners, the participants
in scheduled events, the owners, sponsors and manufacturers of all racing
equipment upon the premises, and the officers, directors, officials representatives,
agents and employees of all of them, OF AND FROM ALL LIABILITY, LOSS, CLAIMS,
DEMANDS AND POSSIBLE CAUSES OF ACTION that may otherwise accrue FROM ANY LOSS,
DAMAGE OR INJURY (INCLUDING DEATH) TO MY PERSON OR MY PROPERTY, in any way
resulting from, or arising from, or arising in connection with, or related
to, any scheduled event, and whether arising while engaged in competition
or in practice or preparation therefore, or while upon, entering or departing
from said premises, from any cause whatsoever including without limitation
the failure of anyone to enforce rules and regulations, failure to make inspections,
or the negligence of other persons. I KNOW THE RISK AND DANGER TO MYSELF
AND PROPERTY while upon said premises or while participating or assisting
in a scheduled event and I DO SO VOLUNTARILY AND IN RELIANCE, not upon property,
equipment, facilities and existing conditions furnished by others,but UPON
MY OWN JUDGMENT AND ABILITY, AND I HEREBY VOLUNTARILY AND KNOWINGLY ASSUME
ALL RISK FOR LOSS, DAMAGE OR INJURY (INCLUDING DEATH) TO MYSELF AND MY PROPERTY
from any cause whatsoever and whether or not attributable in whole or in part
to the negligence of others.
I hereby certify that I assume
all responsibility for all charges, premiums, and taxes, if any, payable on
any funds that I may receive as a result of my competitive activities, including
without limitation social security taxes, unemployment insurance taxes, compensation
insurance, income taxes and withholding taxes.
I hereby make oath and say to the
best of my knowledge and belief all statements set forth in this report are
true and correct and I have read the above Liability Release.
........................................................................ *** MUST BE WITNESSED BELOW!! ***
________________________________ ______/______/_______ ____________________________
(1) APPLICANT'S SIGNATURE
(2) DATE OF BIRTH (3) WITNESS
SIGNATURE
(TO BE COMPLETED IF APPLICANT IS UNDER 18 YEARS OF AGE)
I am the parent or legal guardian of (4)____________________________________________________
"PRINT APPLICANT'S NAME
If married, I have the authority of my
spouse to sign this agreement as the spouse's agent and on the spouse's behalf.
I understand that my signature, under oath, may subject me to penalties of
perjury if any of the above statements are not true and correct.
In consideration of, and as inducement
to TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA EVENTS AND/OR TRAIL-WAY SPEEDWAY,
permitting my child to enter the property and/or to participate in a racing
event sponsored by TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA EVENTS AND/OR
TRAIL-WAY SPEEDWAY, I, for myself, my spouse (if married), my heirs, personal
representatives and assigns do waive and release any and all damages and claims
which I, or they may have against TRAIL-WAY SPORTS CLUB, INC. DBA/ MOTORAMA
EVENTS AND/OR TRAIL-WAY SPEEDWAY and/or other leased property owners or any
of them, their officers, directors or employees or by reason of any loss,
damage or injury (including death) which may occur to applicant and further
for myself, my heirs, personal representatives, assigns and my spouse (if
married) I do agree to indemnity and save harmless TRAIL-WAY SPORTS
CLUB, INC. DBA/ MOTORAMA EVENTS AND/OR TRAIL-WAY SPEEDWAY and/or other leased
property owners, their heirs, successors and assigns, and their officers,
directors, employees, sponsors and all others associated with the entry form
any and all liability, loss claims, demands and possible causes of action
that accure to myself, my spouse (if married), or the applicant by reason
of participation in the event or entry upon the premises where the event
is being held.
NOTARY
SEAL BELOW: (MUST BE NOTORIZED BY A NOTARY WITH A PARENT
FOR ANY
MINOR
UNDER 18 YEARS OLD)
| 5) SUBSCRIBED AND SWORN TO BEFORE ME:
THIS______ DAY OF____________________, 20______ SIGNATURE OF PERSON ADMINISTERING OATH __________________________________________________ S |
(6) I HAVE HEREUNTO AFFIXED MY HAND & SEAL
THIS______ DAY OF ________________, 20______ PRINT PARENT OR GUARDIAN'S SIGNATURE ___________________________________________________ PARENT OR GUARDIAN'S SIGNATURE (7)_________________________________________________ |