PARTICIPANT APPLICATION FOR A LICENSE TO ENTER THE RESTRICTED AREA AS A DRIVER

Each person must possess a Florence Motor Speedway license to enter the restricted pit area. By signing below. I acknowledge having read, understand and voluntarily signed this application. I agree to abide by the current rules and regulations of Florence Motor Speedway and as they may be amended from time to time. I understand and agree to accept any and all penalties, suspensions and decisions against me by officials of Florence Motor Speedway. I understand Florence Motor Speedway official's decisions are final, with no recourse or appeal. This license may be revoked at any time by Florence Motor Speedway. Florence Motor Speedway licenses are non-transferable and must be presented at the restricted Pit sign-in area when you purchase a pit permit. You cannot purchase a general admission ticket to the restricted area. All persons 12 yrs. and older are required to possess a Florence Motor Speedway License and pit permit at all times they are in the restricted area. THIS ENTIRE LICENSE AGREEMENT IS IN EFFECT ANY TIME YOU ARE ON FLORENCE MOTOR SPEEDWAY PROPERTY.

APPLICANTS NAME: ___________________________________________________________________

STREET ____________________________________________________________________________________________

CITY: ______________________________________________ STATE____________________________

ZIP CODE:__________________________ DATE OF BIRTH___________________________________

TELEPHONE # (HOME) A/C__________________________ WORK A/C________________________

SOCIAL SECURITY # ____________________________ E' MAIL ______________________________

q DRIVER

RACE DIVISON: _____________________________CAR / TRUCK# __________________________

EVERY DRIVER MUST HAVE A FLORENCE MOTOR SPEEDWAY LICENSE “NO LI CENSE”; “NO PRIZE MONEY”; “NO POINTS”!!!!

DRIVER LICENSE FEE : (YOUNG GUNS $25) (STREET STOCK $40) (4 CYL. STK., $40)

(SUPER STOCK $40) (LIMITED LATE MODEL $60) (LATE MODEL $80) (SUPER TRUCK $80)

NO MONEY WILL REFUNDED FOR “LICENSE FEE”, “PIT PERMIT FEE” OR

“ANY ENTRY FEE” FOR ANY POSTPONED OR CANCELED EVENT!!!!

YOU MUST PROVIDE A VALID DRIVERS LICENSE OR YOUR SOCIAL SECURITY CARD

By signing below I acknowledge that I understand motor sports racing can be a dangerous sport and the

pit-infield area is restricted to participants, those persons involved with a race car or truck. I accept full

responsibility for injury to myself and release Florence Motor Speedway from all liability of any injury

and or property damage.

SIGNATURE______________________________________________ DATE_____________________

SPEEDWAY OFFICIAL ___________________________________ DATE_____________________