September 4th 4 cylinder DEMO Registration Form

Registration fee $25 (NO REFUNDS). This covers car registration only. Pit entrance $20.00 everyone who enters the pit area. Entry fees may be paid by cash, money order, or Visa/Master Card
PREREGISTER AND SAVE
PAID REGISTRATION RECEIVED BY SEPTEMBER 12TH TAKE $10.00 OFF YOUR REGISTRATION FEE!!
Guaranteed purse paid to top three 1st. $800 2nd. $300 3rd. $100
Driver’s name______________ ________________________________
Nick Name______________________________ Car # Requested__________________
Date of Birth____________________ Age__________Social Security #_______________________
Home Phone____________________________Work Phone_________________________________
Mailing Address________________________________ ________________
City______________ ____________State___________Zip code____ _____
Home Town___________________________________________________(If different from mailing)
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, fill out information below
Name of Insurance Company/Plan Agent
Agent’s Phone Address
Car Make________________________Model__________________Year_______
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 vent, 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.
I have read the rules and will accept the decisions of the judges as final, and elect to use the grounds and track in its present condition.
Date Driver Signature
MAIL TO: Bear Ridge Speedway P.O. Box 273 Bradford VT 05033
VISA & MASTERCARD ENTRIES: card # Name on Card: Expiration date: 3 digit code on back:
1. All persons entering must sign a release and waiver form.
2. Officials reserve the right to reject any entry. Decisions of officials and scorers are final.
3. No refunds for entries that do not pass inspection for rules clearly stated on demo rules sheet.
INTERPRETATION OF RULES BY AN OFFICIAL IS FINAL. THE MANAGEMENT RESERVES THE RIGHT TO CHANGE ANY RULE OR RULES IF THEY FEEL IT IS NECESSARY, AND REFUSE ANY PROTEST IF THEY FEEL IT IS UNNECESSARY AND BEING USED FOR HARASSING REASONS. ALL FINES AND/OR SUSPENSIONS WILL BE IN EFFECT AT ALL BEAR RIDGE SPEEDWAY EVENTS.
THE INTERPRETATION AND INVOKING OF THE RULES PUBLISHED HERIN SHALL BE DETERMINED BY BEAR RIDGE SPEEDWAY OFFICIALS ONLY IN THEIR PROFESSIONAL DISCRETION.
BEAR RIDGE SPEEDWAY INC.
OWNED AND OPERATED BY C.V. ELMS III APRIL MAY PRESTONCELL 603/443-0640 FAX 603/787-2490 TRACK PHONE 802/222-4052WWW.BEARRIDGESPEEDWAY.COM