APPLICANT*S NAME __________________________________________________________________

ADDRESS __________________________________CITY __________________ STATE_____ ZIP ____________

SOCIAL SECURITY # ___ ___ ___ -___ ___-___ ___ ___ ___PHONE #___ ___ ___-___ ___ ___-___ ___ ___ ___

DRIVER*S LICENSE #__________________________BIRTH DATE ____/_____/_____
DIVISION ________________________CAR#_________ DRIVER ________ $75.00 Pit Crew _________ $50.00
 *Advertising and Promotion Release:  Victorville Auto Raceway is duly authorized agent and assigns, any use 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 Victorville Auto Raceway sanctioned event(s), including but not limited to television and radio broadcasts, film production, video tape reproductions and the like, and do hereby relinquish all rights thereto for these purposed.

PLEASE READ THE FOLLOWING SECTION CAREFULLY

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
IN CONSIDERATION of being permitted to compete, officiate, observe, work for, or participate in any way in the EVENT(S) or being permitted to enter for any purpose any RESTRICTED AREA (defined as any area requiring special authorization, credentials, or permission to enter or any area to which admission by the general public is restricted or prohibited), THE UNDERSIGNED, FOR HIMSELF/HERSELF, HIS/HER PERSONAL REPRESENTATIVES, HEIRS, AND NEXT OF KIN: I hereby apply for membership at Victorville Auto Raceway and authorize Victorville Auto Raceway to represent my interest as they may appear in auto racing matters.  I acknowledge that I am familiar with the current rules of Victorville Auto Raceway and agree to abide by them. I agree that I shall be the sole spokesperson for myself, the car owner, and the crew in all matters pertaining to compliance with the rules and regulations and I agree and understand that I am responsible for the conduct of my crew. I agree and understand that the burden of proof will rest upon me to show that I am in compliance with all of the V.A.R. rules and regulations, and understand violation of various rules can result in a fine, suspension and loss of track points.  I agree to appropriately use all required stickers and decals and I understand that failure to do so may result in loss of points and forfeiture of all money and awards related to sponsors of the division. I agree that all decisions of V.A.R. track officials regarding the interpretation and application of the rules, scoring of positions, shall be non-litigable. I further covenant and agree that I will not initiate any type of legal action against Victorville Auto Raceway or a V.A.R  promoter, to challenge such decisions, to seek monetary damages, to seek injunctive relief or to seek any other kind of legal remedy. I understand that if I pursue any such legal action, which violates this provision, then I expressly agree to reimburse V.A.R., for all of its attorney's fees and costs in defending against such legal action.  I understand that all points are awarded to the driver. I further understand that there is no express of implied warranty of safety resulting from publication of compliance with any division rules and that they are intended as a guide for the conduct of the sport and are in no way a guarantee against injury or death to participants, spectators of others.   I understand this license is not transferable and may be suspended by Victorville Auto Raceway pursuant to the provisions of Victorville Auto Raceway rules.  I further certify that I am an independent contractor and not an agent, servant of employee of Victorville Auto Raceway.  I will retain such status as an independent contractor in the event Victorville Auto Raceway approves my membership.  I acknowledge and assume all responsibility for any charges, record keeping, premiums, and taxed, if any, payable on any funds I may receive as a result of my activities as Victorville Auto Raceway member, including but not limited to, Social Security taxes, Workers Compensation Insurance, income taxes and withholding taxes. I certify that at the time of signing this application, I meet the minimum requirements, and that all of the information of this application is correct and I will be held accountable if it is not.

Signature_______________________________________________________ Date _______________________