2009 Application

If applicant is under 18 years of age, a MINOR/PARENT release must be signed and filed with this application. This form must be neatly printed, or typed and filled out in full. Illegible forms will be rejected.

                                                                                         Use this application to become a TTR member

Kart #                      Class:                                                                         CHECKS PAYABLE TO KATE MAILLE    $25

If you need more membership applications, feel free to copy this one.

Full name______________________________________________________________________

Address________________________________________________________________________

City________________________                             State__________________________                              Zip_______________________________

Phone____________________________                    Date of Birth_______________________                                Place of Birth____________________________

Employed by:________________________________________                                                           Phone___________________________

Address:____________________________________________                                  City__________________________       State__________________________                   Zip __________

Do you have any handicaps or disabilities?     Yes___          No_____                             If yes, describe: _____________________________________________________________

Date of last physical exam _____________                                                          Physical Condition _________________________________

Do you currently have health insurance?                      Yes_____                         NO ______               If yes, please describe: _____________________________________________

Name of insurance company/plan ____________________________                                                                                Address __________________________________

  Agents Name __________________________________                                                                  Agents Phone  ____________________________             

Advertising Release:   The undersigned consents to the use of his/her name before and after relinquishes any right to photos taken in connection with events and consents to the publication or sale of such photos by TTR.           SAFETY RELEASE: I hereby give up all my rights to sue or make any claim against the Turkey Trot Raceway and it's organizers, promoters, sponsors, and all other persons or organizations conducting or connected with this event for any injury to property or person I may suffer, including crippling injury or death, weather such injury arises while I am preparing or participating in the event or while I am upon the event premises.  I know the risks of danger to myself and my property while participating in the event, and while upon the event premises and relying upon my own judgement and ability, assume all such risks of loss and hereby agree to reimburse all cost to those persons or organizations connected with this event for damages incurred as a result of any injury that I cause or receive.   ARBITRATION:  Any dispute, controversy, or claim involving the undersigned member, whether or not relating to this agreement or alleged breach of same, shall be settled in accordance with the existing and/or amended rules and regulations of the association and the undersigned agrees to accept the decision rendered in the process. I understand there will be no refund of membership fees once paid for any reason.                    Date:____________  Signature:__________________________________________________________     Fee must be paid at time of application. TTR reserves the right to reject this or any application.

Money Race