Northern Vintage Snowmobile Race Series
2008 Vintage Grass Drags Driver Entry Form
www.NVSRS.org OR info@NVSRS.org
Contact:
Jan jkb54362@charter.net OR 715-362-4182
PLEASE
PRINT Sled # _________________ DOB _______________________
Last First
Name
________________________________________________________ Name ______________________________________
Address ________________________________________________ City
______________________________ State__________
Zip __________________ Phone
__________________________ Email
_____________________________________________
|
|
CLASS |
YEAR |
MANUFACTURER |
MODEL |
FEE |
|
1 |
75
& Older Stock Single Cyl. Fan F/A |
|
|
|
$5.00 |
|
2 |
85
& Older Stock Single Cyl. Fan F/A |
|
|
|
$5.00 |
|
3 |
85 & Older Mod
Single Cyl. Fan F/A |
|
|
|
$10.00 |
|
4 |
0-300
STOCK Fan |
|
|
|
$5.00 |
|
5 |
0-400
STOCK Fan |
|
|
|
$5.00 |
|
6 |
0-503
STOCK Fan |
|
|
|
$5.00 |
|
7 |
0-550
STOCK Fan |
|
|
|
$5.00 |
|
8 |
0-300
STOCK Free Air |
|
|
|
$5.00 |
|
9 |
0-400
STOCK Free Air |
|
|
|
$5.00 |
|
10 |
0-503
STOCK Free Air |
|
|
|
$5.00 |
|
11 |
0-550
STOCK Free Air |
|
|
|
$5.00 |
|
12 |
0-300
STOCK Liquid |
|
|
|
$5.00 |
|
13 |
0-400
STOCK Liquid |
|
|
|
$5.00 |
|
14 |
0-503
STOCK Liquid |
|
|
|
$5.00 |
|
15 |
0-550
STOCK Liquid |
|
|
|
$5.00 |
|
16 |
0-399
Stock Bogie Wheel |
|
|
|
$5.00 |
|
17 |
400
& Up Stock Bogie Wheel |
|
|
|
$5.00 |
|
18 |
Mod Any CC Bogie Wheel |
|
|
|
$10.00 |
|
19 |
0-300 MOD Fan F/A |
|
|
|
$10.00 |
|
20 |
0-400 MOD Fan F/A |
|
|
|
$10.00 |
|
21 |
0-503 MOD Fan F/A |
|
|
|
$10.00 |
|
22 |
0-550 MOD Fan F/A |
|
|
|
$10.00 |
|
23 |
1972 & Older MOD Fan
F/A |
|
|
|
$10.00 |
|
24 |
0-300 MOD Liquid |
|
|
|
$10.00 |
|
25 |
0-400 MOD Liquid |
|
|
|
$10.00 |
|
26 |
0-503MOD Liquid |
|
|
|
$10.00 |
|
27 |
0-550 MOD Liquid |
|
|
|
$10.00 |
|
28 |
Heavy MOD Fan F/A
Liquid Any CC |
|
|
|
$10.00 |
|
29 |
Woman
0-300 Fan F/A |
|
|
|
$5.00 |
|
30 |
Woman
0-503 Fan F/A |
|
|
|
$5.00 |
|
31 |
Woman 0-503 MOD Fan F/A |
|
|
|
$10.00 |
|
32 |
Juniors
0-300 STOCK 11-17 years old |
|
|
|
$5.00 |
|
33 |
120s
STOCK 3-6 years old |
|
|
|
$5.00 |
|
34 |
120s
STOCK 7-10 years old |
|
|
|
$5.00 |
|
35 |
120s MOD 6-12 years old |
|
|
|
$5.00 |
|
|
TOTAL REGISTRATION COST +
ADDITIONAL $5.00 INSURANCE
FEE PER DRIVER |
|
|||
Stock Classes are trophy classes only. Mod
classes are cash payback only (with exception of Mini 120 Mod).
Minimum of three entries per class to race
If minimum is not reached, entry fees will be refunded for that class.
SIGNATURE
_________________________________________________________________ DATE ______/______/______
PARENTS SIGNATURE
_______________________________________________________ DATE ______/______/______
17 years and
under must be accompanied to registration with a parent or legal guardian.
Verification
and signatures required.
(TURN
OVER FOR WAIVER)
Northern Vintage Snowmobile Race Series
Release and Waiver of Liability,
Assumption of Risk and Indemnity Agreement
In CONSIDERATION of being
permitted to compete, officiate, observe, work for, or participate in any way,
in the EVENTS or being permitted to enter for any purpose, any RESTRICTED AREAS
(Defined as any area requiring special authorization, credentials, or
permission to enter, or any other area to which admission by the general public
is restricted or prohibited), EACH OF THE UNDERSIGNED, for himself/herself,
his/her personal representatives, heirs, and next of kin:
1.
Acknowledges, agrees, and
represents that he/she has or will immediately upon entering any of such
RESTRICTED AREAS, and will therefore, inspect the RESTRICTED AREAS which he/she
enters and he/she further agrees and warrants that if at anytime, he/she is in
or about RESTRICTED AREA and he/she feels anything to be unsafe, he/she will
immediately advise the officials of such and will leave the RESTRICTED AREAS
and/or refuse to participate further in the EVENTS.
2.
HEREBY RELEASES, WAIVES,
DISCHARGES, AND COVENANTS NOT TO SUE the promoters, participants, affiliated
associations, sanctioning organizations, or any subdivision thereof, track
operators, track owners, officials, racers, pit crew, rescue personnel, any
persons in any RESTRICTED AREA, sponsors, advertisers, owners and lessee/users
of the premises used to conduct EVENTS, premises and event inspectors,
surveyors, underwriters, including those who give recommendations, directions,
or instructions, or engage in the risk, loss control activities or sales
regarding the premises or EVENTS and each of these, their directors, officers,
agents and employees, FROM ALL LIABILITY TO THE UNDERSIGNED, his/her personal
representatives, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE AND ANY
CLAIM OR DEMANDS THEREFORE ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR
RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENTS,
WHETHER CAUSED BY NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
3.
HEREBY AGREES TO IDENTIFY
AND SAVE AND HOLD HARMLESS the releases and each of them FROM ANY LOSS,
LIABILITY, DAMAGE, and/or COST they incur out of or related to the EVENTS
WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.
4.
HEREBY ASSUMES FULL
RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising
out of or related to the EVENTS whether caused by NEGLIGENT RESCUE OPERATIONS
OR PROCEDURES OF THE RELEASEES.
5.
HEREBY acknowledges that
THE ACTIVITIES OF THE EVENTS ARE VERY DANGEROUS and INVOLVE THE RISK OF SERIOUS
INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE. Each of THE UNDERSIGNED also
expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY
NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
6.
HEREBY agrees that this
Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement
extends to all acts of negligence by the RELEASES, INCLUDING NEGLIGENT RESCUE
OPERATIONS and is intended to be as broad and inclusive as is permitted by the
laws of the State in which the EVENTS are conducted and that if any portion
thereof is held invalid, it is agreed that balance shall not withstanding,
continue in full legal force and effect.
I
HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND
INDEMNITY AGREEMENT AND FULLY UNDERSTAND THE TERMS, UNDERSTAND THAT I HAVE
GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND
VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME
AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL
LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
PARTICIPANT
(PRINT) NAME _______________________________________________________________
SIGNATURE
_____________________________________________________ DATE
______/______/_______
PARENT/GUARDIAN
(PRINT) NAME _________________________________________________________
SIGNATURE
_____________________________________________________ DATE ______/______/________
Revised 10/28/07