Send Form to: Reads Racing Unlimited, Inc. C/O Lori Locklin 313 EMS R4 Lane Pierceton IN 46562
Reads Racing Unlimited, Inc. Membership Form
Last Name _________________ First__________________Middle______ Address__________________________________ City ______________________________ State ___________ Zip_______ Email: ______________________________________________________ Jacket Size ____________
Please circle all that apply:
QUAD A QUAD B A B C YOUTH AUTO
I understand that Reads Racing Unl. cannot assume responsibility for any aspect of my safety and that if I participate in any organized meet, I do so voluntarily on my own assessment of my ability, the course, and all facilities and conditions, assuming all risk; and I release and hold Reads Racing harmless for any injury or loss to my person or property which may result there from. I understand that this means that I agree not to sue Reads Racing for any injury resulting to myself or my property at any such meet.
Applicant signature (required) _______________________________ Date ______________ Parent or legal guardian if minor _____________________________ Date ______________ Issued by ______________________________________ Date_______________________
Enclosed is:______________________ for (#) ______________ memberships.