2010
TRACK LICENSE & REGISTRATION
Algona Raceway ~ Fairmont Raceway ~ I-35 Speedway ~Hancock County Speedway
P.O. BOX 659, ALGONA, IA 50511
REGISTRATION:
Reserved Parking: Circle Track(s)
Before February 1, 2010 $20 $30
per Track
After February 1, 2010
$25
$_________Fairmont
Raceway
Fairmont Raceway
$_________Algona
Raceway
Algona Raceway
$_________I-35 Speedway I-35 Speedway
$_________Hancock County Speedway Hancock County Speedway
DRIVER ____________________________________ CLASS___________________ CAR#___________
ADDRESS___________________________________ SOCIAL SECURITY
#________________________
CITY______________________________________ STATE_______________
ZIP_____________________
DATE OF
BIRTH_____________________ JACKET SIZE_____________________
HOME PHONE # ________________________ CELL
#____________________
CAR OWNER________________________________
1099 to driver? ____________ If not –payee name
_________________________________
MUST BE FILLED OUT OR
DRIVER WILL RECEIVE 1099
PAYEE SOCIAL SECURITY #________________________
PAYEE ADDRESS______________________ CITY______________
STATE_______ZIP_____________
Sponsors__________________________________________________________________________________________
_________________________________________________________________________________________________
AGREEMENT
CONTRACT:
I hereby certify that I am an independent contractor. Assuming all
responsibility for money received as a
result of
my activities at the Raceway, including without eliminating, income taxes, FICA,
workman’s compensation. I am not an employee, servant or agent of the Raceway.
CONSIDERATION & COMPLIANCE:
In
consideration of acceptance by the Raceway of this application and payment of
registration & license fees the undersigned agrees to abide by all the rules and
regulation of the Raceway as to conduct and mechanical applications as now
published or hereafter modified. The undersigned further recognizes his
obligation to the public and to the Raceway, which posts the prize monies and
conducts the events and agrees to compete in all events for which he may be
qualified. We reserve the right to refuse anyone due to slander, libel,
defamation, etc.
BREACH &
DAMAGE:
In
the event the undersigned breaches this agreement, he shall be liable for actual
and liquidated damages sustained by the Raceway as a direct or indirect result
of such breach.
BENEFITS:
I
understand and agree that myself and my executors and assigns will be entitled
to the benefits of the Competitor Accident Insurance Policy procured by the
Raceway for accidental death or injuries which occur as the result of external,
violent and visible means sustained in Raceway events. The coverage of said
policy shall constitute the limit of liability of the Raceway for such injuries
occurring to me an any Raceway event, provided proper notification of such
occurrence is filed with the Raceway.
ADVERTISING RELEASE:
The undersigned consents to the use of his name and/or pictures of himself and
his car for publicity, advertising and endorsements, both before and after
events, and relinquished any rights to photos taken in connection with events,
and consents to the publication or sale of such photos by the Raceway. This
includes any video or delayed transmission of images.
ARBITRATION:
Any
dispute, controversy or claim involving the undersigned, whether or not relating
to this agreement of same, shall be settled in accordance with existing and/or
amended rules and regulation of the Raceway, and the undersigned agrees to
accept the decision rendered by such process.
BY MY
SIGNATURE BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT.
I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE RULES OF THE RACEWAY.
SIGNATURE_________________________________________________
DATE_______________
PARENT/GUARDIAN OF MINOR__________________________________