2008 Pit License Application

Applicant Name__________________________________________________________

Social Security #_____________________ **Date of Birth:_____________________

**Applicants under 18 years of age must include a notarized release signed by Parent or Legal Guardian, giving permission to participate in racing activities. No one under the age of 12 will be allowed in Pit Area.

Street Address____________________________________________________________

City_______________________ State________________ Zip Code_____________

Phone # __________________ Emergency Contact #______________________

Division_____________________________

Car # ________________ (Please Note: Cars painted identical or back up cars, must be numbered differently-NO DUCT TAPE NUMBERS)

(Check one): Driver_____ Owner_____ Crew Member_____

Pit License Fee: $75.00 ($10.00 replacement fee will be charged for lost licenses)

It is recommended that ALL TEAMS reserve a Pit Pad. If you do not reserve a Pit Pad, You may be re-located anywhere in the pit area by Track Management based on Special Events, Arrival Time at Speedway, Etc.

(circle if enclosing payment)

Reserved Concrete Pad (Mods only): $100.00
Reserved Paved Pit Pad: $100.00
All Other Reserved Pads: $50.00

I, the undersigned, have read, understand, and agree to obey and be bound by all the rules, regulations and requirements set forth by Mountain Speedway. I will make no claim nor file any action/actions against Mountain Speedway. I agree to refrain from any types of public demonstrations, public picketing or vocal airing of grievances in public on the day of scheduled race meet at Mountain Speedway. All those who fail to adhere to the above will be dealt with according to the law and face immediate forfeiture of their Mountain Speedway Pit License. Mountain Speedway Pit License shall be considered a privilege. Management reserves the right to refuse any application and return fee without showing cause.

Mail Form with Payment To: Make Check Payable To: Mountain Speedway

Mountain Speedway
Box 381-L
Route 924 Humboldt                                      SIGNED x __________________________________

Hazleton, PA. 18202                                      DATED:_______________