Nor-Cal Dwarf Car Association

6095 Rainier Avenue

Rocklin, CA 95677

(209)832-8508 (Jan)

2008 PIT Membership Application

NAME:

ADDRESS

CITY STATE: ZIP

PHONE #: .CELL#

EMAIL ADDRESS

BIRTHDATE: ______________________

DRIVER'S NAME ( if applicable) Car Number

ANNUAL DUES: $30.00 each. Membership expires 11/31.

I hereby apply for membership in the N.C.D.C.A.

Liability release: In consideration of the acceptance of the right to participate, entrants, participants, and spectator's, by the execution of this form, release, and discharge the NCDCA and their officer's director's, employees, agents, representatives, members, and servants and anyone else connected with the management for this event of and from any and all injuries and damages, whether the same is known or unknown, inquires, losses, judgements, and or claims from any causes or damages whatsoever that may be suffered by an entrant to his person or property. Further, each entrant, participant, or spectator expressly agrees to indemnify and hold harmless all of the foregoing entities, firms, persons, and bodies of and from any and all liability occasioned or resulting from the conduct of entrants or any and all liability occasioned or resulting from the conduct of entrants or any participants assisting or cooperating with entrant or any participants assisting or cooperating with entrant and under the direction and control of entrant.

SIGNATURE OF APPLICANT: DATE: