Lehigh Valley Quarter Midget Racing Club

2016 ICE BREAKER APPLICATION and RELEASE

FORM

           

Sunday, April 3, 2016 Sign In begins at 9:00 a.m.

Car Tech begins at 10:00 a.m. Practice begins at 11:00 a.m. Racing begins at 12:00 p.m.      

 I, the undersigned, agree to participate in the Ice Breaker Race on April 3, 2016 sponsored by the Lehigh Valley Quarter Midget Racing Club, the Club. I agree to abide by the charter, constitution, and rules of operation of the Club. No express or implied warranty of safety shall result from publications of, or compliance with, the rules and/or regulations of the Club. The rules are intended as a guide for the conduct of the sport and are in no way a guarantee against injury or death to a participant, spectator, or official. The Executive Board is empowered to permit minor deviations from any of these rules where, in their opinion, the safety of any participant, spectator, or official is in question. In all matters, the ruling of the Executive Board of the Club shall be final. The undersigned shall indemnify and save harmless the LVQMRC and Pocono International Raceway from all liability arising from injury or damage to personal property of any nature. The LVQMRC reserves the right to refuse any application.

 Requirements:

1. Driver(s)/handler(s) must be current active members of a recognized quarter midget club (ID required). 2. Driver must have appropriate quarter midget driving experience. 3. Driver/car must pass brake test and safety inspection before competing. 4. Engine(s) must meet club/class rules for the class registered. For example: LVQMRC/novice. 5. All cars must have LVQMRC compatible transponder. (Own or Rent)

 List only ONE driver per application, print clearly please

Car Owner: Address:

Phone Number: City: State: Zip Code:

           

Driver: Age: Club:

Class: Car #: Transponder #: Pick #:

Class: Car #: Transponder #: Pick #:

Handler #1: Handler #2:

Cost: $30 for Car + Driver + 2 Handlers $30 Driver Participation in an additional class $10 Transponder Rental $10 TOTAL: Please make check payable to LVQMRC

 

LVQMRC MEMBERS ENTRY FORM

  Owner Signature:

     Date:

 LVQMRC, P. O. Box 21803, Lehigh Valley, PA 18002 Questions call: 610.517.8862 Approval: Date: _