2001 CREDENTIAL APPLICATION

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2001 CREDENTIAL APPLICATION













Please type or print legibly and complete all of the requested information.
Name: ____________________________________________________
Mailing Address: ____________________________________________
___________________________________________________
___________________________________________________
Home #: ________________________
SS #: ____________________
Business #: ____________________ Fax #: _____________________
Email Address: _____________________________________________
Team Name: ________________________
Birth Date: ____________
FOR DRIVERS ONLY:
Home Town: ________________________________________________
Previous Racing Licenses Held: ______________________________________________________________________
Type of Racing/Cars/Years Run: ______________________________________________________________________
I hereby apply for membership as indicated in Professional Sports Car Racing, Inc. (SPORTS CAR) and authorize SPORTS CAR torepresent my interests as they may appear in auto racing matters. I acknowledge that I am familiar with the current rules of SPORTS CARand Star Mazda Series and agree to abide by the current rules of SPORTS CAR and Star Mazda Series as they may be amended fromtime to time. I understand that this credential is not transferable and may be suspended by SPORTS CAR pursuant to the provisions ofthe 2001 SPORTS CAR Code Book as it may be amended from time to time. I further certify that I am an independent contractor and notan agent, servant or employee of SPORTS CAR, and that I will retain such status as an independent contractor in the event mymembership and credential application is approved by SPORTS CAR. I acknowledge and assume all responsibility for any charges,record keeping, premiums and taxes, if any, payable on any funds I may receive as a result of my activities as a SPORTS CAR member,including, but not limited to social security taxes, unemployment insurance taxes, worker compensation insurance, income taxes andwithholding taxes.
RELEASE: SPORTS CAR, Valley Motor Center Racing Inc., DBA Star Mazda Series and their duly authorized agents and assigns, mayuse the APPLICANTS name, likeness and photographs of the APPLICANT or the APPLICANTS cars, including photographs of theAPPLICANT or the APPLICANTS cars taken during the EVENT(S), in any way, medium or material, for promoting, advertising, recordingor reporting an SPORTS CAR sanctioned EVENT(S) before, during and after such EVENT(S), including, but not limited to television andradio broadcast film production, videotape reproductions and the like, and do hereby relinquish all rights thereto for these purposes.
I understand that acceptance of this membership application and fee by any SPORTS CAR official does notconstitute approval of the application, and that all applications must be approved by SPORTS CAR Headquarters.
APPLICANTS LEGAL SIGNATURE x _________________________________
Date _________________________