2007 Race of Champions Asphalt Modified Tour Membership Application
Applicant Name: ___________________________________________ Car #: _____________
(car
numbers will not be assigned until roc office receives receipt of paid membership
application)
Applicant
Address: _____________________________________________________________
(please
print and fill out completely)
__________________________Zip Code:
______________
S.S #: _______-______-______
Birth Date: ____/____/____ Phone Numbers: (h) __________________ (w) _________________
Cell Phone Number: ___________________ Email Address: __________________________
Driver Website: ______________________ Other Car # Choices: _____________________
Car Owner: ____________________________ S.S #: _______ - _______ - _______
Owner Address:
_____________________________________________ Zip Code: __________
Phone Numbers: (h) ____________________ (w) __________________ (c)
___________________
THE PERSON THAT ANY PURSE OR
POINT FUND MONIES ARE PAID TO SHOULD BE LISTED
ABOVE AS CAR OWNER WITH COMPLETE INFORMATION PROVIDED.
Every driver competing in one or all events must file a tour membership
application. A Race of Champions
Membership Card will be sent to each driver for identification purposes.
Crew Members may purchase a discounted membership making them eligible for possible
admission discounts and other contingency programs. All members will have one vote for regional and
overall “crew member of the year” awards.
Please Check One: Crew Membership: $35 __________ (includes both regions)
Driver
Membership:
1 Event Temp: $50 ______
1 Region: $70 ________ 2 Regions:
$125 ______
If purchasing
membership for only 1 region please indicate which region here: ______________
IN CONSIDERATION of the
acceptance of this Race of Champions Modified Tour Membership Form, I for
myself, my heirs, next of kin, personal representatives and assigns, FOREVER
RELEASE, REMISE and FOREVER DISCHARGE and AGREE TO HOLD HARMLESS and INDEMNIFY
the promoters presenting races or other events, the owners (lessors)
of the premises at which these events are held, the participants, theron, and the owners, sponsors and manufacturers of all
racing equipment used in any of these events, the officers, directors, agents,
employees and servants of all of them, including officials and Race of
Champions Modified Tour members, of and from all liability, claims, action and
of possible causes of action whatsoever.
Including negligence of any of the foregoing, that may accrue to me or
my heirs, next of kin and personal representatives from every and any loss,
damage and injury, including death, that may be sustained by my person and
property while in or about and enroute into and out
of any Race of Champions Modified Tour event.
By Signing this 2007
Race of Champions Modified Tour membership Form I acknowledge that I have read
the entire form and understand its contents.
The Race of Champions Modified Tour has consent to use driver name and
likeness for promotional and souvenir materials. This Race of Champions Membership may be
revoked at any time for failure to adhere to tour rules, implied or
assessed.
Applicant Signature: _____________________________ Date
Signed: _______________
Checks may be made
payable to: Race of Champions,