2010 PASSORS Membership

[ ] Stadium Trucks
[ ] Stadium Limited UTV
[ ] Modified 250 Stadium Kart
[ ] Mini Stock 50cc or less (4-6)
[ ] Mini Stock 51-90cc (4-6yrs) 		[ ] Stadium Unlimited Buggies
[ ] Junior 1 Stock Stadium Kart
[ ] Modified 450 Stadium Kart  
[ ] Mini Mods 50cc or less (4-6)
[ ] Mini Mods 51-90cc (4-6yrs)  		[ ] Stadium Limited Buggies
[ ] Junior 1 Stadium Kart
[ ] Stadium Pro Quad
[ ] Mini Stock 50cc or less (7-9)
[ ] Mini Stock 51-90cc  (7-9yrs) 		[ ] Stadium Unlimited Pro UTV 
[ ] Junior 2 Stadium Kart
[ ] Stadium Amateur Quad
[ ] Mini Mods 50cc or less (7-9)
[ ] Mini Mods 51-90cc  (7-9yrs)
[ ] Open Quad Class (10-12yrs)     
     		Paid $75 ________________________
Car #_______   (All car numbers must be approved and can be reassigned by the PAS)     Transponder#______________. 



________________________________________________________________________________________________ 
Name                                             Phone Number                                                               Cell Phone

________________________________________________________________________________________________ 
Street                                 City                                 State                                                     Zip

________________________________________________________________________________________________ 
PAYEE                                                                                                     SOCIAL SEC # OR TAX ID#

E-Mail Address                                                                                                                                                                                                   

Emergency Contact                                                                                                                                                                                               
                                           Name                                    Address                                                      Phone

Sponsors (list three)____________________________________________________________________________

ANY driver, crew, member, spectator or car may be banned from the facility for whatever reason and period the management desires.
  

In consideration of PASSORS and/or their designee granting to me a license to participate in sanctioned events, and to complete for prize money, or other remuneration’s, or to enjoy participation in scheduled sporting events, I hereby grant to said PASSORS, et al. and/or their designee:

FIRST:  All fees, salaries or other remuneration, including residuals derived from any movie items, television, radio, advertising or other entertainment media derived from my activities as a participant in any PASSORS sanctioned event.

SECOND:  The exclusive right to publish, sell or use in any fashion, photographs of me or my equipment, with remuneration or notice to me.

THIRD:  A complete and unconditional release on behalf of myself and heirs for any injuries sustained by me while participating in any sanctioned event, or any damage to my property sustained while participating in any sanctioned event.

As a condition under which PASSORS agrees to issue me a license to participate in sanctioned events, I affirm the following representations:

FIRST:  My participation in any sanctioned event shall be on a voluntary basis, in which event I shall be acting solely for myself as an independent contractor.  I will not act as an agent, servant of employee of PASSORS or any other person or organization if I participate in any event.
 

SECOND:  If, as a result of my voluntary participation in any sanctioned event, I win any prize money ore receive other remuneration’s, I do so as an independent contractor, and will maintain all necessary financial records and make all necessary tax returns. 

THIRD:  As a voluntary participant in any sanctioned event, acting solely on my behalf as an independent contractor, I recognize the fact that PASSORS does not provide workers’ compensation insurance, unemployment insurance, unemployment disability insurance, federal old-age survivors insurance, state or federal taxes, or any other insurance.

FOURTH:  As a voluntary participant in any sanctioned event, I fully recognize the possibility of injury to my person and damage to my property, and I freely assume this risk as a participant in any sanctioned event.  Further, I hold PASSORS and its affiliates harmless in the event of such injury to my person or damage to my property.

FIFTH:  I have read and understand this application for a participant’s license.  I fully understand the application contains a general release to all persons in any way connected with a sanctioned event, for any personal injuries I sustain or any damage to my property. 

SIXTH:  I am 18 years of age or older or have filed with PASSORS a Minor’s Release Form approved by my parents or guardian.

I HAVE READ AND FULLY UNDERSTAND THIS WAIVER AND RELEASE OF LIABILITY AND WAIVER OF INDEMNITY AND I KNOW AND UNDERSTAND THAT MY SIGNATURE ON THIS FORM RELEASES PASSORS, TOGETHER WITH ITS OFFICERS, DIRECTORS, OFFICIALS, REPRESENTATIVES, AGENTS AND AFFILIATES FROM ANY AND ALL LIABILITY, INCLUDING NEGLIGENCE, AND I FREELY AND WILLINGLY CONSENT TO THIS WAIVER AND RELEASE OF LIABILITY AND WAIVER OF INDEMNITY AGREEMENT.
 

SIGNED:                                                                                               

     DATED:                                                                                

Perris Auto Speedway, 18700 Lake Perris Drive, Perris, CA  92571, Phone:  (951) 940-0134, Fax:  (951) 940-0634