2010 WMRA Membership Application
Please Check One:
5 OWNER/DRIVER ($150)
5 OWNER ($100)
5 DRIVER ($100)
5 ASSOCIATE ($50)
5 OFFICIAL ($0)
5 GOLD CARD ($0)
Address: ___________________________________________________
City, State, Zip: _____________________________________________
Home Phone: _____________________________________________
Work Phone: _____________________________________________
Email Address: _____________________________________________
Date of Birth: _____________________________________________
Social Security # (Owners/Officials Only): ___________________________
Where applicable, I agree to receive WMRA newsletters and other correspondence at the email address above instead of in the mail.
___ Yes ___ No
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Car Number: 1st Choice ______ 2nd Choice ______ 3rd Choice ______
Chassis Type and Year: __________________________________________________
Engine Type and Year: __________________________________________________
Sponsors: ______________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Be sure to read and sign the release and waiver with this application. The application is
not complete without your signature on the release and waiver.
Annual Release and Waiver of Liability,
Assumption of Risk and Indemnity Agreement
In consideration of being granted an annual membership and/or competition license and in consideration of being permitted to enter for any purpose any “restricted area” (herein defined as the entire racing facility including, but not limited to the racing surface, the pit area, infield, garage areas, parking areas, and all walkways, roadways, concession areas and other areas appurtenant to any area where any activity related to the competitive racing event shall take place).
Release and Waiver of Liability: I, for myself, my heirs, next of kin, personal representatives and assigns, hereby release, waive, discharge and covenant not to sue the Washington Midget Racing Association (WMRA), its successors and assigns, the race organizers presenting WMRA events, the owners and lessees of premises on which WMRA events take place, the participants in WMRA sanctioned events, (including car owners, drivers, mechanics, pit crews, and any persons in any restricted area.), promoters, sponsors, advertisers, manufacturers of all racing equipment in any restricted area, officers, directors, officials, representatives, agents and employees of all of them (all of whom for the purpose herein are referred to as “releasees”) from all liability, loss, claims, demands, causes of action, court costs, attorneys fees and other expenses that may otherwise accrue from any loss, damage, or injury (including death) to my person or property in any way resulting from or arising in connection with, or related to any WMRA sanctioned event, and whether arising while engaged in competition or in practice or preparation therefore, or while upon, entering or departing from any restricted area, from any cause whatsoever including without limitation, any failure to enforce rules and regulation, any failure to make inspections, or any negligence on the part of the releasees or any other persons.
Assumption of Risk: I know that there is danger to myself and my property, both from known risks and unanticipated risks, while I am in any restricted area or while I am attending, participating in, or assisting in a WMRA sanctioned event. I assume all such risks of loss, damage or injury (including death) to myself and my property from any cause whatsoever and whether or not attributable to the negligence of the releasees or any other persons. I assume all such risks willingly, voluntarily, and in reliance upon my own judgment and ability, and not in reliance upon the property, equipment, facilities or services provided by others.
Indemnity Agreement: I hereby agree to indemnify and hold harmless the releasees and each of them from any loss, liability, damage or cost they may incur due to the presence of the undersigned in or upon the restricted area, whether caused by the negligence or the releasees or otherwise.
Permission to use Name and Likeness: I hereby give permission to the WMRA and its representatives to use my name and my likeness including photos and videos or other images of myself, my crew, and my race cars to promote the WMRA, midget racing, and in any other way the WMRA and its representatives choose to use them.
Promotional Agreement: I hereby agree to help promote any race sponsor, series sponsor, contingency sponsor or any other entity that the WMRA has agreed to promote. I agree to display stickers, decals, and patches on my race car, race car trailer, drivers uniform or in any other way that the WMRA and its representatives have agreed to promote a sponsor. Failure to do so will result in forfeiture of any monies that said sponsors have contributed.
Printed Name: _______________________________________________________
Signature: _______________________________________________________
Date: _______________________________________________________
Mail application and signed waiver to:
WMRA
18524 190th St. SW
DuPont, WA 98327