2014 Race Car Registration Form - Central PA Dirt Trackin’ Show (York, PA)

Date: 1/1/2014 8:05:15 PM


2014 Race Car Registration Form
Central PA Dirt Trackin’ Show (York, PA)


Set Up Day: Thursday, January 23, 2014 (12:00 p.m. – 8:00 p.m.)

Show Days: Friday, January 24 to Sunday, January 26, 2014

Registration Fee – None (Deadline for Registration: Postmarked by Monday, January 13, 2014).

All Registrants will receive two-(2) complimentary weekend passes per vehicle. Failure to have registration postmarked by Monday, January 13, 2014 will result in only one-(1) complimentary weekend pass.

Set Up – All cars may be moved into the hall on Thursday, January 23, 2014 from 12:00 p.m. to 8:00 p.m. Please check which hall the car is to be displayed before unloading (East or West Hall). If you cannot have your car delivered at this time, you must have special permission first (email toddafish@aol.com or call 717-292-1696) or your car may be denied entry.

Judging - All car judging will be held before the doors open at 4:00 p.m. on Friday, January 24. Awards will include Best of Show; Best Open Wheel; Best Stock Car; Best Late Model; Best Quarter Midget; Best Kart and more.

Removal – No car may be removed from the hall until the show closes on Sunday, January 24 at 4:00 p.m. All cars must be removed by 10:00 p.m. on Sunday night (no exceptions).

Questions - Email toddafish@aol.com or call 717-292-1696 (www.dirttrackinshow.com)

Please print clearly or type (below):
Name of Driver:__________________________________________________________________________
Address:__________________________________________________Apt. _____________
City, State, Zip:__________________________________________________________________________
Phone (home):_____________________(work):______________________ (cell):_____________________
Email Address:__________________________________________________________________________
Emergency Contact name & number:_________________________________________________________
Owner Name (if different):___________________________________________________________________
Type of Car (Sprint, Late Model, Stock Car, Quarter Midget, etc.):________________________________________
Car Number:___________

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AGREEMENT / RELEASE (Please read carefully)
I hereby certify that I am an independent contractor, assuming all responsibility for moneys received as a result of my participation in the Central PA Dirt Trackin’ Show (hereafter known as “CPDTS”) events, including without eliminating, income taxes, FICA, workmen’s compensation, and withholding taxes. I am not an employee, servant or agent of CPDTS. In consideration of acceptance by CPDTS of this application and payment of prizes, the undersigned agrees to abide by all rules and regulations of CPDTS as to conduct and requirements, as now published in the entry form or hereafter modified.
The undersigned consents to the use of their name and/or pictures of them or their vehicle for publicity, advertising, endorsements, both before and after the CPDTS events, and relinquishes any rights to photos taken in connection with CPDTS events, and consents to the publication or sale of such photos by CPDTS. Any dispute, controversy or claim involving the undersigned
applicant, whether or not relating to this agreement or alleged breach of the same, shall be settled in accordance with the existing and/or amended rules and regulations of CPDTS, and the undersigned agrees to accept the decisions rendered by such process.

BY MY SIGNATURE BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT. I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE REQUIREMENTS OF THE RULES.
Applicant’s Signature:_______________________________________ Date:_______________________
Please return this form (signed and dated) to:
Central PA Dirt Trackin’ Show, 3805 Natalie Lane, Dover, PA 17315. Phone/Fax (717) 292-1696






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