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)

400/500 CC

400/500 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)

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.

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(Required)

American Express

Discover

MasterCard

Visa

Card Number Exp. Date Security Code