374 Myrtle Street
New Bedford, Ma 02746
www.seniortourautoracers.com
Phone #508-999-1480 E-Mail stars62@banet.net Fax 508-990-1487
APPLICATION FOR MEMBERSHIP YEAR 2012 DUES $25.00
RENEWAL________________________ NEW_____________________________
Please Print
Name______________________________________Spouse______________________
Street______________________________________
City_______________________________________State_________Zip_____________
Telephone#_______________Fax#________________E-Mail______________________
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______________________