2010 Pit License Application & Car Number Registration
This pit license application does not
guarantee your car number!
(Numbers will be assigned on a first come, first serve
basis. Please provide a 1st and 2nd choice for car number. - NO
DUPLICATE NUMBERS WILL BE PERMITTED!!!)
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.
City_______________________ State________________ Zip Code_____________
Phone # __________________ Emergency Contact #______________________
Car# 1st choice______ 2nd choice______ 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
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
627 Can-Do Expressway
Twp., PA 18202