Nor-Cal Dwarf Car Association

C/O Connie Bender

6095 Rainer ave

Rocklin, Ca. 95677

209)836-4722 (Jan)

2008 PIT Membership Application

Name:_______________________________________________________

ADDRESS:____________________________________________________________

CITY___________________ STATE:____________________ ZIP:___________

PHONE #:_______________________CELL. #________________________________

EMAIL ADDRESS:____________________________________________

BIRTHDATE:_____________________________

DRIVER'S NAME ( if applicable) ____________________________

______________________________________________________________________

ANNUAL DUES: $30.00 each. Membership expires 11/31.

I hereby apply for membership in the N.C.D.C.A.

Liability release: In consideration of the acceptance of the right to participate, entrants, participants, and spectator's, by the execution of this form, release, and discharge the NCDCA and their officer's director's, employees, agents, representatives, members, and servants and anyone else connected with the management for this event of and from any and all injuries and damages, whether the same is known or unknown, inquires, losses, judgements, and or claims from any causes or damages whatsoever that may be suffered by an entrant to his person or property. Further, each entrant, participant, or spectator expressly agrees to indemnify and hold harmless all of the foregoing entities, firms, persons,and bodies of and from any and all liability occasioned or resulting from the conduct of entrants or any and all liability occasioned or resulting from the conduct of entrants or any participants assisting or cooperating with entrant or any participants assisting or cooperating with entrant and under the direction and control of entrant.

SIGNATURE OF APPLICANT:________________________DATE:_______________