SHADYHILL SPEEDWAY 

10554 West  300 North        Medaryville, IN  47957        219-843-8892

DRIVER’S IDENTIFICATION CARD APPLICATION – FEE $10.00

All drivers must have identification cards.  Identification cards must be presented when drawing for position and at pay window after racing.  PAYOUTS WILL NOT BE MADE WITHOUT ID CARDS.  Please print the following information clearly:

SOCIAL SECURITY NUMBER  ________________--____________--________________                               CAR NUMBER  _______________

FIRST                                                                          LAST                                                                                  MIDDLE

NAME_________________________________       NAME_____________________________________        INITIAL______________________

CLASS    {   }  UMP MODIFIED        {   }  UMP STOCK CAR     {   } INDEPENDENT MODIFIED                     DATE OF BIRTH:

(MARK ONE)   {   }  PURE STREET         {   }  TEEN-4s                     {   } GUEST CLASS__________________      ________ / ________ / _________

MAILING                                                                                                                                                                                             ZIP

ADDRESS_____________________________________________ CITY____________________________ STATE_______  CODE_________

PHONE # W/                                                                                   JACKET SIZE                                      SPOUSE’S

AREA CODE_____________--________________________      (CIRCLE ONE)       S  M  L  XL  XXL            NAME____________________________

SPONSORS_________________________________________________________________________________________________________

SEND END OF SEASON 1099 TO ABOVE APPLICANT?        {   }  YES            {    }  NO -  IF NO, COMPLETE THE FOLLOWING

SOCIAL SECURITY NUMBER  _______________--___________--_______________          DATE OF BIRTH  ________--________--________

FIRST                                                                          LAST                                                                                  MIDDLE

NAME_________________________________       NAME_____________________________________        INITIAL______________________

MAILING                                                                                                                                                                                             ZIP

ADDRESS_____________________________________________ CITY____________________________ STATE_______  CODE_________

SIGNATURE OF

     CONTRACT: I am an independent contractor assuming all responsibility for monies received as a result of my activities including without eliminating income tax, FICA, workman’s compensation and withholding taxes.  I am not an employee, servant or agent of Shadyhill Speedway.

     BENEFITS: I agree that myself, Executors and assigns will be entitled only to the benefits of the Competitor Accident Policy procured by the speedway for accidental injuries which are the result of external, violent and visible means sustained in speedway events.  The foregoing shall constitute the limit of liability of the speedway for such injuries occurring to me in any speedway event provided proper notification is given.

     COMPLIANCE: The undersigned agrees to abide by all the rules and regulations of the speedway now published or hereinafter modified.  In consideration of acceptance by the speedway of this agreement (Shadyhill Speedway), the undersigned recognizes his/her obligation to the public and the speedway, which posts the prize money and conducts the event and agrees to compete in all events, when qualified, if humanly possible.

     BREACH & DAMAGE: In the event the undersigned breaches this agreement, he/she shall be liable for actual and liquidated damages by the speedway.

     ADVERTISING RELEASES: The undersigned consents to the execution of photographs upon speedway’s request and the use of his/her name, pictures of himself/herself and his/her race car for publicity, advertising and endorsements both before and after the events, and relinquishes the right to photos taken in connection with events and consents to the publication or sale of such photos as the speedway so desires.

     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 the speedway and the undersigned agrees to accept the decision rendered by this process.

I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT.  I AGREE TO ABIDE BY ALL THE TERMS OF THIS AGREEMENT AND THE REQUIREMENTS OF THE RULES OF SHADYHILL SPEEDWAY.

                                                               LEGAL

DATE:_______________________      SIGNATURE_________________________________________________________________________