LICENSE APPLICATION (2009 License Fee: $40)) First Name Last Name Address City State Zip Phone E-mail EMERGENCY CONTACT Name Phone Have you ever held a roadracing license? Yes No Yes Organization Requested number Option #1 Option #2 Option #3 Date of Birth If you are under 18 you legally can't agree so you must have a parent or guardian sign the printable version and mail it in. I have read this application in it's entirety and stipulate, under the penalty of perjury, that all statistical information set forth herein by me is true and accurate and complete. In consideration for granting me a competition license by the Florida Mini Roadracing Association, LLC (hereafter referred to as FLAMRA), and in consideration of the promotion and operation of roadrace events by FLAMRA, and in consideration of granting of permission to enter, use and remain on the track facilities and/or premises at which these events take place by the owners and representatives thereof, I hereby, for myself, my heirs, personal representatives and assigns, release, discharge, and agree to hold blameless and indemnify FLAMRA, it's representatives, the owners and representatives of the aforementioned track facilities and/or premises, as well as directors, officers, agents, employees and/or members of all of them and from any liability, loss, claims, demands and possible causes of action that may otherwise accrue from any loss, damage, injury (including death) to my person and property, in any way a result from, or arising in connection with, or related to any event, and whether arising, while engaged in competition or in practice or preparation thereof, while upon entering or departing from said track facilities and or premises, from any cause whatsoever including without limitation, the failure of anyone to enforce rules or regulations, failure to make inspections, of the negligence of other persons. I understand that motorcycle racing competition can constitute a hazardous activity and that by reason of my application for a FLAMRA roadrace license and /or participation in or presence at any competition event, I am assuming all risks and hazards related thereto. I agree that FLAMRA may use my name and likeness, including pictures of my racing equipment and pictures taken at any event, for the purpose of media and promotion. I agree to abide by FLAMRA rules and respect the authority of the race officials and personnel at all events. I hereby confirm, consent and agree to the foregoing.
LICENSE APPLICATION (2009 License Fee: $40)
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First Name Last Name
Address
City State Zip
Phone E-mail
EMERGENCY CONTACT
Name Phone
Have you ever held a roadracing license?
Yes No Yes Organization
Requested number
Option #1 Option #2 Option #3
Date of Birth
If you are under 18 you legally can't agree so you must have a parent or guardian sign the printable version and mail it in.
I have read this application in it's entirety and stipulate, under the penalty of perjury, that all statistical information set forth herein by me is true and accurate and complete. In consideration for granting me a competition license by the Florida Mini Roadracing Association, LLC (hereafter referred to as FLAMRA), and in consideration of the promotion and operation of roadrace events by FLAMRA, and in consideration of granting of permission to enter, use and remain on the track facilities and/or premises at which these events take place by the owners and representatives thereof, I hereby, for myself, my heirs, personal representatives and assigns, release, discharge, and agree to hold blameless and indemnify FLAMRA, it's representatives, the owners and representatives of the aforementioned track facilities and/or premises, as well as directors, officers, agents, employees and/or members of all of them and from any liability, loss, claims, demands and possible causes of action that may otherwise accrue from any loss, damage, injury (including death) to my person and property, in any way a result from, or arising in connection with, or related to any event, and whether arising, while engaged in competition or in practice or preparation thereof, while upon entering or departing from said track facilities and or premises, from any cause whatsoever including without limitation, the failure of anyone to enforce rules or regulations, failure to make inspections, of the negligence of other persons. I understand that motorcycle racing competition can constitute a hazardous activity and that by reason of my application for a FLAMRA roadrace license and /or participation in or presence at any competition event, I am assuming all risks and hazards related thereto. I agree that FLAMRA may use my name and likeness, including pictures of my racing equipment and pictures taken at any event, for the purpose of media and promotion. I agree to abide by FLAMRA rules and respect the authority of the race officials and personnel at all events. I hereby confirm, consent and agree to the foregoing.
