2013 Oglethorpe Speedway Park
Driver License Application
___Late Model ___Street Stock
___Pure Stock ___Mini Stock ___440
Full Name:___________________________________________________ Nickname:_________________________________
Social Security Number:____________________________________ Birthdate:______________________________________
Home Phone Number:___________________________________ Cell Phone Number:_______________________________
Personal Insurance Company:_________________________________ Policy Number:_______________________________
In Case of Emergency, Notify:________________________________________________________________________________
Relationship:___________________________________________ Phone Number:____________________________________
Car Number:______________ Year, Make & Model of Race Car:________________________________________________
Remit to: Oglethorpe Speedway Park - PO Box 687 - Pooler, GA 31322
I am an independent contractor assuming all responsibility for
money received as result of my speedway activities including income
tax, FICA, workers compensation and withholding taxes. I am not
an employee, servant or agent of Oglethorpe Speedway Park.
I agree that myself, Executors and assigns will be entitled only
to benefits of the Competitor Accident Policy procured by the Speedway
for accidental injuries which are a result of external, violent and
visible means sustained in Speedway events. The foregoing shall
consitute the limit of liability of Oglethorpe Speedway Park for such
injuries occuring to me in any Speedway event provided proper
notification is given.
COMPLIANCE: The undersigned agrees
to abide by all rules and regulations of the Speedway now published or
hereinafter modified. The undersigned acknowledges having read,
understood and voluntarily understands this agreement and the rules of
the Speedway and agrees to abide by the current rules and regulations
of Oglethorpe Speedway Park now published and hereinafter modified.
In consideration of the acceptance by the Speedway of this
agreement, the undersigned recongnizes his/her acceptance to all
Oglethorpe Speedway Park official's decisions, penalties and
suspensions with the possibility of the membership being revoked at any
time when this agreement has been breached. The undersigned
understands that stock car racing can be a dangerous sport and the pit
area is restricted to those persons involved with the race car.
The undersigned accepts full responsibility for injury to
themselves and releases Oglethorpe Speedway Park from all liability
resulting from any injury.
ADVERTISING RELEASE: The
undersigned consents to the use of his/her name, pictures or video of
himself/herself and their car for publicity, advertising and
endorsements both before and after the events, and relinquishes any
rights to photos or footage taken in connection with events and
consents to the publication of sale of suc photos as the Speedway so
ARBITRATION: Any controversy or claim arising out
of or relating to this agreement, including any alleged breach, shall
be settled in accordance with the rules and regulations of this
Speedway and the undersigned agrees to accept the decision rendered by
I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT.
I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE
REQUIREMENTS OF ALL THE RULES SET FORTH BY OGLETHORPE SPEEDWAY PARK.