Membership Application

Granite State Mini Sprints Membership Contract (Election to Election) With Release of Liability and Indemnity Provisions.

Or fill out the online form below

Step 1 of 5 - Car Information

Please provide your 1st, 2nd, and 3rd choices for your car number below

Select a Car Number

If you don't get your first choice a fallback will be used.

First Choice(Required)

Please enter a number from 0 to 99.

Second Choice(Required)

Please enter a number from 0 to 99.

Third Choice(Required)

Please enter a number from 0 to 99.

Select the relevant classes for this application(Required)

500 CC

500 CC Rookie

600 CC

600 CC Rookie

Temporary One Night Race

500 CC Class Payment(Required)

Please select your membership level (This includes a $2.00 convenience fee.)

500 CC Rookie Class Payment(Required)

Please select your membership level (This includes a $2.00 convenience fee.)

600 CC Class Payment(Required)

Please select your membership level (This includes a $2.00 convenience fee.)

600 CC Rookie Class Payment(Required)

Please select your membership level (This includes a $2.00 convenience fee.)

Temporary / One Night Class Payment(Required)

Please select your membership level (This includes a $2.00 convenience fee.)

Date of Birth(Required)

Name(Required)

Address(Required)

Street Address City State ZIP Code

Driver Email(Required)

Home Phone(Required)

Work Phone

Cell Phone(Required)

Emergency Contact Name(Required)

Emergency Phone(Required)

Emergency Email

Do you have allergies(Required)

Yes

No

Allergies (Drivers Only)(Required)

Blood type? (Drivers Only)(Required)

PLEASE READ CAREFULLY BEFORE SIGNING

In consideration of being permitted to join Granite State Mini Sprints. (Hereinafter called “GSMS”) and being permitted to participate in or be a spectator at GSMS membership events during 2021.

Consent(Required)

I hereby

Release, waive, discharge, and promise not to sue GSMS, any of its officials, any of its members, any of its sponsors,
or car owners, drivers, pit crews, for personal injury or property damage which I sustain during the racing season arising
out of a GSMS event, whether my loss is caused by the negligence of GSMS or its members. This does not waive rights
of suit in the event that an action is termed criminal within the jurisdiction of applicable law.

I agree to indemnify and hold harmless GSMS, its officials and members for any loss, liability, damage, or cost which
may incur due to my presence at a GSMS event, whether I am competing, officiating, or observing a GSMS event.

I assume the risks inherent in automobile racing and assume responsibility for the bodily injury or property damage
which those risks can cause.

I reserve to GSMS and its members and officials, any rights to publish, produce, copyright, duplicate, reproduce upon
hats, tee-shirts, and other such novelty concession items, written articles about me, photos and drawing of my likeness
or of my racecar. This does not prohibit me from producing promotional products, nor does this allow GSMS to take
any proceeds from material produced by me, unless marketed by GSMS.

By signing below, I agree to follow all the rules and regulations and responsibilities as printed in the GSMS rules. I
hereby release the officials of rom damages resulting from their decisions and/or interpretations of rules.

I have read the forgoing and understand its contents and I agree that if any of the paragraphs or provisions of this
contract are deemed illegal, the rest of the document shall stand in full force and effect.

Driver's Signature(Required)

I HAVE READ THIS DOCUMENT and I UNDERSTAND IT IS A RELEASE OF CERTAIN CLAIMS. I UNDERSTAND I ASSUME ALL RISKS INHERENT IN AUTOMOBILE RACING. I VOLUNTARILY SIGN MY NAME ACCEPTANCE OF THE ABOVE PROVISIONS.

Signature of Parent and/or Guardian of Minor

Contact Information of Parent and/or Guardian of Minor

Name of Parent and or/Guardian of Minor(Required)

First Last

This email will be sent a receipt for payment.

Contact Email(Required)

Total

Review your information

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Billing Address(Required)

Street Address City State ZIP Code

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Exp. Date Security Code