UNITED AUTO RACING ASSOCIATION

IMPORTANT: PAGE 2 OF THIS APPLICATION MUST BE READ AND SIGNED BY APPLICANT BEFORE IT WILL BE CONSIDERED

THE ACCEPTANCE OF THIS APPLICATION AND THE APPLICATION FEE BY ANY OFFICIAL OF UNITED AUTO

RACING ASSOCIATION (“UARA”) DOES NOT CONSTITUTE APPROVAL OF THIS APPLICATION. THIS APPLICATION

LAST NAME: _______________________________ FIRST NAME: ______________________ OR INITIAL:_________

ON OFFICIAL RESULTS AND POINTS I WOULD LIKE MY NAME TO READ:________________________________

MAILING ADDRESS: _______________________________________________________________

CITY: ___________________________________ STATE: ____________________ ZIP CODE:__________________

CELL PHONE: (_____)_____________________________ HOME PHONE: (____)__________________

DATE OF BIRTH: ________________________________ SOCIAL SECURITY NUMBER ________________________

EMPLOYER: __________________________________________________________________________________

IN CASE OF EMERGENCY NOTIFY: _________________________________ PHONE (____) __________________

APPLICANT’S HOMETOWN: __________________________________HOME TRACK:_____________________________________

______ Owner - $175.00 ________ Driver - $175.00 ________COMBO (For Driver who is also Owner) - $300.00

________Crew - $ 50.00 ________ Temp - $ 50.00 (one race only) (After 4 paid Temps annual license will be issued)

Car # Desired _________ 1st choice _________2nd choice ________3rd choice__________

I am the applicant identified on page one of this application. I hereby apply for membership in United Auto Racing Association

(“UARA”) and a license to participate in UARA-sanctioned event's) (“Events”) in the category indicated on the reverse side hereof.

UARA RULES. I am familiar with the current UARA Rule Book, including vehicle specifications and safety rules, and I agree to abide

by such rules as they may be amended from time to time. I further agree that the driver shall be the sole spokesperson for himself, his car

owner, and his crew in all matters pertaining to compliance with the rules, and I understand that the driver is responsible for the conduct of

his crew. I further agree and understand that by submitting my racecar for various technical and safety inspections, I certify that the racecar

meets all the rules for participation in the Events. I understand that the burden of proof will rest upon me to show that I am in compliance

with all UARA rules, and I understand that a violation of the rules may result in a fine or suspension and/or loss of points and/or for forfeiture

of money and awards for the Events. I further understand that all points, awards and money earned will be paid to the driver subject to adjustment

NO CONTEST. I agree that all decisions of UARA race officials, or the track officials, regarding the interpretation and application of UARA

rules and the scoring of positions shall be non-litigable. I further agree that I will not initiate any type of legal action against UARA, or a

UARA promoter, to challenge such decisions, and that UARA is and shall be the sole owner of any and all copyrights, intellectual property rights,

and proprietary rights worldwide in and to these works and in and to any other works, copyrightable or otherwise, created from the images, sounds

and data arising from or during the Events. In addition and to the extent not already owned by UARA, I hereby assign to UARA, its successors and

assigns, exclusively and in perpetuity, any and all rights set forth above. I represent and warrant that, as of the date of this Application, I have not

granted to any third party the rights described herein. I agree to take all steps reasonably necessary, and all steps requested by UARA, to protect,

perfect or effectuate UARA’s ownership or other interest in these rights. I agree not to take any action, nor cause others to take any action, nor enter

into any third party agreement, which would contravene, diminish, or infringe upon these rights.

_________________________________________ ________________________________________________________ _____________

THIS SECTION MUST BE CAREFULLY READ AND SIGNED BY APPLICANT IN CONSIDERATION OF BEING PERMITTED

TO ENTER FOR ANY PURPOSE THE RESTRICTED AREAS, defined as including but not limited to the racing surface, pit areas,

infield, paddock area, grandstand area, and all walkways, concessions, and other areas appurtenant to any area where any activity related to the

events shall take place (“Restricted Areas”), or being permitted to compete in, officiate, observe, work for, or for any purpose participate in any

way in the Events. Applicant, for himself /herself, his/her personal representatives, heirs, and next of kin, acknowledges, agrees and represents that:

He/she has inspected the Restricted Areas, and/or will immediately upon entering the Restricted Areas, and will continuously thereafter, inspect the

Restricted Areas and all portions thereof, and he/she further agrees and warrants that his/her entry upon the Restricted Areas and his/her participation,

if any, in the Events constitutes an acknowledgement that he/she has inspected the Restricted Areas and that he/she finds and accepts the same as being

safe and reasonably suited or the purposes of his/her use; and he/she further agrees and warrants that, if at any time he/she in or about the Restricted Areas

and feels anything to be unsafe, he/she will refuse to participate in the Events, will immediately advise an official of such unsafe situation and will promptly

He/she assumes all responsibility for and risk of bodily injury, death or property damages due to the negligence or gross negligence of Releasees while in or

upon the Restricted Areas and/or while competing in, officiating, observing, working for or for any purpose participating in the Events. He/she also expressly

acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releases or others.

He/she releases and discharges the promoters, participants, racing association, sanctioning organization or any subdivision thereof, track operator, track owner,

officials, vehicle owners, drivers, pit crews, any persons in the Restricted Areas, sponsors, advertisers, owners and lessees of the premises used to conduct the

Events, premises or event inspectors, surveyors, insurers, underwriters, consultants or other persons for entities who give recommendations, directions, or

Instructions or engage in risk evaluation or loss control activities regarding the premises or the Events, their parents, subsidiaries, wholesalers, affiliated

corporations, and each of them, and the directors, officers, agents and employers of each of them (“Releasees”) from all liability to the Applicant, his/her

personal representatives heirs and next of kin, or any and all loss or damage, and any claim or demand therefore an account of injury to the person or property

or resulting in death of the undersigned, whether caused by the negligence or gross negligence of the Releasees or otherwise, while the Applicant is in or upon

the Restricted Areas, and/or competing in, officiating, observing, working for, or for any purposes participating in the Events.

He/she agrees to indemnify and save and hold harmless UARA and all other related parties from any loss, liability, damage, or cost they may incur due to the

Presence of the undersigned in or upon the Restricted Areas or in any way competing in, officiating, observing, working for, or for any purpose participating

in the Events and whether caused by the negligence or gross negligence of UARA or otherwise.

APPLICANT EXPRESSLY ACKNOWLEDGES THAT THE ACTIVITIES OF THE EVENTS ARE VERY DANGEROUS AND INVOLVE THE RISK OF

SERIOUS INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE AND THAT HIS/HER HEIRS AND NEXT OF KIN HAVE BEEN SO ADVISED.

He/she further expressly agrees that the foregoing Release and Waiver of Liability an Indemnity Agreement is intended to be as broad and inclusive as is

permitted by law of the State in which the Events are conducted and that, if any portion thereof is held invalid, the balance shall continue in full legal force

THE UNDERSIGNED ACKNOWLEDGES THAT HE/SHE HAS READ AND UNDERSTANDS THIS RELEASE AND WAIVER OF LIABILITY AND

INDEMNITY AGREEMENT, and he/she further acknowledges that no oral representations, statements or inducements apart from the foregoing written

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