Membership And License Application Form And Rellease Form printable pdf download

MEMBERSHIP AND LICENSE APPLICATION FOR THE 2016 RACING SEASON

I hereby apply for membership in East Alabama Motor Speedway, Inc., hereafter East Alabama Motor Speedway, Inc., and authorize

East Alabama Motor Speedway, Inc. to represent my interests as they may appear in auto racing matters. I acknowledge that I am

familiar with the current rules of East Alabama Motor Speedway, Inc. and agree to abide by them. I understand this license is not

transferable and may be suspended by East Alabama Motor Speedway, Inc. pursuant to the provisions of East Alabama Motor

Speedway, Inc. rules. I acknowledge and assume all responsibility for any charges, record keeping, premiums, and taxes, if any,

payable on any funds I may receive as a result of my activities as an East Alabama Motor Speedway, Inc. member, including but not

limited to Social Security taxes, unemployment insurance taxes, Workers Compensation insurance, income taxes and withholding

taxes.

PLEASE FILL IN BELOW (PRINT OR TYPE)

APPLICANT’S NAME: ______________________________________________________

SSN: _____-_____-_______ BIRTHDATE: ____/_____/__________

ADDRESS:_______________________________________________________________

CITY: _________________________ STATE: _________ ZIP: _____________

HOME PHONE: ____________________ CELL PHONE: _________________________

DRIVER’S LICENSE: _________________ EXP. DATE: ____/_____/_____

CAR #: ________ DRIVER: ______________________________________

DIVISION: ___________________ E-MAIL ______________________________________

POINT FUND DIVISIONS: (Circle One if Applicable)

EAMS Late Model

Limited Late Model

Hobby

Road Warrior

Hot Shots

In order to be eligible for points funds/prizes, driver must race 80% of ALL points races

FEES: $50 fee to join the points. Pit Pass $25.00 at Pit Gate (Special Events have a higher pit price)

Drivers running in more than one class must purchase one driver pit pass per vehicle entered. Additional

Pit Pass will be paid at registration.

RACEceivers are also required any time you are on the racetrack. RACEceivers are available for

purchase at the East Alabama Motor Speedway Parts House.

Advertising and Promotion Release: East Alabama Motor Speedway Inc., it’s duly authorized agent and assigns, is herby

granted the right of uses of the applicant’s name, likeness and photographs of the applicant or the applicant’s car(s), taken

during the event, in any medium or material, for promoting, advertising, recording, or reporting any East Alabama Motor

Speedway, Inc. sanctioned event(s), including but not limited to television, and radio broadcasts, film production, video tape

Membership And License Application Form And Rellease Form