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 THIS FORM MUST BE FILLED OUT IN FULL CAR NUMBER AND DIVISION MUST BE COMPLETED!!

OWNER FULL NAME                                                                   I.R.S. Reporting# __                                       DRIVER FULL NAME (if different than owner)                                                                                                 
ADDRESS                                                                                                                                                                
CITY                                                               STATE                                    ZIP CODE                                         
PHONE                                                          EMAIL ADDRESS:                                                                        
Date of Birth                           Place of Birth                         (If) driver, license # & state                                      
Employed by:                                                                                        phone                                                           
Address                                                                       City                            State                  Zip Code                  
Emergency contact                                                     Relation                                     Phone                                   
Do you have any handicaps or disabilities?  Yes   No   If yes, describe on back of this form & sign.
Date of last physical exam                                            Physical Condition                                                   
Do you currently have health insurance? Yes   No   If yes, Name of Insurance Company/Plan                         Agent                                      Phone                           Address                                                                                
Driver must have valid 2008 BRS Car owner/driver License to be eligible for competition trophy and pay. TO GUARANTY PRIOR YEAR NUMBER THIS APPLICATION AND PAYMENT MUST BE RECEIVED BY MARCH 1, 2008. By signing this application you agree to having received and read and understand the 2008 rules for BRS.  DRIVER AND/OR OWNER MUST PURCHASE A TICKET AND BE PRESENT AT ANNUAL AWARDS BANQUET TO RECEIVE ANY POINT FUND MONEYS, TROPHIES, AND CONTINGENCY ITEMS.
ADVERTISING RELEASE: The undersigned consents to the use of his/her name and/or pictures of him/herself and his/her car, for publicity, advertising and endorsement both before and after events and relinquishes any rights to photos taken in connection with events, and consents to the publication or sales of such photos by BRS.
SAFETY RELEASE: I hereby give up all my rights to sue or make any claim against the BEAR RIDGE SPEEDWAY and their organizers, promoters, sponsors and all other persons or organizations conducting or connected with this event for any injury to property or person I may suffer, including crippling injury or death, whether such injury arises while I am preparing for or participating in the event or while I am upon the event premises.
I know the risks of danger to myself and my property while participating in the event, and while upon the event premises and relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all cost to those persons or organizations connected with this event for damages incurred as a result of any injury that I cause or receive.
ARBITRATION: Any dispute, controversy or claim involving the undersigned member, whether or not relating to this agreement or alleged breach of same, shall be settled in accordance with the existing and/or amended rules and regulations of the Speedway and the undersigned agrees to accept the decision rendered in the process. I understand there will be no refund of membership fees once paid for any reason.
Date                                        Legal Signature                                                                                                         
Fee must be paid at time of application. BRS reserves the right to reject this or any other application
If applicant is under 18 years of age, a MINOR/PARENT RELEASE must be signed and filed with this application.