2009 Deerfield Raceway Membership Agreement   - $25.00 fee

Division _____________   Car #  _______          Membership #___________

NAME:  Last  ____________________   First  ____________________ MI  _____

ADDRESS:  Street  ____________________________________________________

                      City  ____________________________________

                      State  ____________  Zip __________

PHONE:  Res ________________________  Cell________________________             

                 Email ___________________________________________________

HEALTH INS:  Ins. Co. _______________________ Policy # ____________________

Drivers License  # ____________________________

BENEFICIARY:  I designate and name as beneficiary: Spouse ____________________

                               Other ___________________________ Name___________________

                               Residence _______________________________________________

I DO AGREE BY SIGNING THIS LICENSE APPLICATION FORM THAT I WILL ABIDE BY ALL THE RULES AND REGULATIONS SET FORTH BY DEERFIELD RACEWAY Inc., INCLUDING BUT NOT LIMITED TO THE FOLLOWING:

INDEPENDENT CONTRACTIONS: I am an independent contractor assuming all responsibility for money received as a result of my activities including but not limited to income tax, FICA, Workmen’s Compensation, and withholding taxes.  I am not an employee or agent of Deerfield Raceway Inc.

RULES: I have or will have familiarized myself with all Deerfield Raceway Inc. rules and regulations nor or hereinafter promulgated, including car specifications and safety rules, and specifically agree to abide by all Deerfield Raceway Inc. rules.

SPOKESPERSON: I agree that I will 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 my crew.

INSPECTIONS: I agree and understand that by submitting my race car for various technical and safety inspections, I certify that the race car meets all rules and regulations for participations Deerfield Raceway Inc. events and that the burden of proof will rest upon me to show that I am in compliance with Deerfield Raceway Inc. rules and regulations.

STICKERS: I agree to appropriately use all required stickers, decals, patches, and I understand that failure to do so will result in loss of points and a forfeiture of all money and awards for the event.

DECISION OF OFFICIALS: I agree that all decision of Deerfield Raceway Inc. race officials, or track officials, regarding interpretation and application of Deerfield Raceway Inc. rules and the scoring of positions, shall be non-litigable.  I further covenant and agree that I will not initiate any type of legal action against Deerfield Raceway Inc. to challenge such decision, to seek monetary damages, to seek injunctive relief or to see any other kind of legal remedy.

SAFETY: I understand that there is no express or implied warranty of safety resulting from publication or compliance with rules of Deerfield Raceway Inc., 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 or others.

BREACH & DAMAGE: In the event the undersigned breaches this agreement, he/she shall be liable for actual and liquidation damages sustained by Deerfield Raceway Inc.

OWNERSHIP: As owner of a registered car, I certify I have marketable title to the competition vehicle, free and clear from liens and will deliver title to said vehicle or any part thereof if claimed pursuant to the rules.

ADVERTISING RELEASES: The undersigned consents to the use of his/her name, pictures of himself/herself and his/her car for publicity, advertising and endorsement both before and after the events, and relinquishes any rights to photos taken in connection with events and consents to the publication or sale of such photos as Deerfield Raceway Inc. desire.

ABILITY TO PERFORM: I certify that I am physically able to compete and I am not a danger to myself or others.

DISPUTES: Any controversy or claim arising out of or relating to this agreement, including any alleged breach, shall be settled in accordance with the rules of Deerfield Raceway Inc. The undersigned agrees to accept the decision as final without appeal.

I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT.  I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE RULES OF Deerfield Raceway Inc.

Date ________________   Signature of License Holder ________________________ Witness __________________________