374 Myrtle Street

                                                              New Bedford, Ma 02746

                                                         www.seniortourautoracers.com

 

Phone #508-999-1480          e-mail  starracing@netzero.com     Fax 508-990-1487

 

APPLICATION FOR MEMBERSHIP YEAR 2015     DUES $25.00

 

    RENEWAL________________________  NEW_____________________________

Please Print

Name______________________________________Spouse______________________

Street______________________________________

City_______________________________________State_________Zip_____________

Telephone#_______________Fax#________________E-Mail______________________

Telephone# Used if you want to receive instance updates/cancellations__________________

Home Track_____________________________________________________________

If car owner Please give brief history:

 

Year____________Make____________Model_________________Car#_____________

Original Driver___________________________Years Ran_________________________

List of Tracks_____________________________________________________________

_______________________________________________________________________

 

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Sole purpose of Senior Tour Auto racers is to preserve the History of Auto Racing and to honor the people who made it what it is today.  Signing this application I agree to abide by the rules and regulations set by Senior Tour Auto Racers Inc.  I further certify that I am an independent contractor and not an agent, servant or employee of Senior Tour Auto Racers Inc. and that I will retain, such status as an independent contractor in the event my membership application is approved.  I further agree to release Senior Tour Auto racing Inc.of any liability for injuries or death that may occur in an event that is sanctioned by Senior Tour Auto Racing Inc.  I also, am aware that my membership can be suspended for violations of any and all rules set forth by Senior Tour Auto Racing Inc.  I am aware that my membership is non transferable and I am over the age of 18 and do hold a valid driver's license.

I have read and voluntarily sign this application on:        Date__________________________

 

Signature________________________________ Date of Birth______________________

 

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