2017 Minor Crew Check-List

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2017 Minor Crew Check-List Following you will find the necessary forms to complete your 2017 IMSA Membership/License application and Annual hard card application.

1 2017 Minor Crew Check-List Following you will find the necessary forms to complete your 2017 IMSA Membership/License application and Annual hard card application. This checklist is meant to assist you in completing the application(s) and ensuring that all the required information and documents are returned to IMSA. Please review the section below and check all boxes that apply to you. Return your application and remittance to IMSA, Member Services Department, One Daytona Blvd., Daytona Beach, FL or Fax to (386) Minor Crew Membership/License Only Membership/License Application Check off Crew Check off applicable Series Sign and date where designated on Application - actual signature is required Note: Crew membership/license does not include the cost of a credential. An event credential may be purchased at registration for $ each for crew members listed on a team roster. Minor Crew Membership/License and Annual Hard Card Credential Membership/License Application Check off Crew Check off applicable Series Sign and date where designated on Application - actual signature is required Annual Credential Application Check off Crew Annual Credential - must be listed on a team roster. (A competitor under 19 years old must submit fully executed emancipated minor documentation to compete in New York). Notarized and fully executed Parental Consent, Release and Waiver of Liability Assumption of Risk, and Indemnity Agreement and Minor s Assumption of Risk Acknowledgment - An original notarized copy must be received - a copy, fax or version cannot be accepted. Photo (Use 2016 photo) Photo Enclosed Photo via (registration@imsa.com) Fees IMSA Crew Membership/License $100 IMSA Crew Annual Hard Card Credential $500 GRAND TOTAL: Please submit to IMSA Member Services Department registration@imsa.com Page 1 of 1

2 Please type or print legibly and complete both sides of this application MINOR MEMBERSHIP/LICENSE AND ANNUAL CREDENTIAL APPLICATION & AGREEMENT ENTRANT, DRIVER & CREW First Name: Last Name: Birth Date: (see minimum age requirements in the 2017 IMSA Rules) IF UNDER THE AGE OF 19, THE APPLICANT MUST ALSO SUBMIT A FULLY EXECUTED PARENTAL CONSENT FORM Home Address: City: State: Zip Code: Country: Address: Mobile #: Business #: Team Name: Emergency Contact: Phone #: IMSA OFFICE USE ONLY Date Received Payment Type Fee Approval Code License # Date Issued Credential Number (DRIVERS Only): Hometown Driver Ranking WEATHERTECH Drivers/Entrants only: Required FIA License # Country of Residency (WeatherTech Drivers only) FIA Country of Issue IMSA SERIES (check all Series that apply) IMSA WEATHERTECH SPORTSCAR CHAMPIONSHIP IMSA CONTINENTAL TIRE SPORTSCAR CHALLENGE LAMBORGHINI SUPER TROFEO SERIES FERRARI CHALLENGE PORSCHE GT3 CUP CHALLENGE USA BY YOKOHAMA ULTRA 94 PORSCHE GT3 CUP CHALLENGE CANADA BY YOKOHAMA IMSA PROTOTYPE CHALLENGE PRESENTED BY MAZDA MEMBERSHIP/LICENSE CLASSIFICATION APPLICATION FEE ENTRANT $ DRIVER $ Approval of this application does not constitute approval to compete in the Series. New driver applicants must also submit a driver résumé before being considered for eligibility in an event. After review of the résumé, IMSA will advise applicant if they are approved and, if so, for what Series and under what conditions. CREW $ NEW MEMBER RENEWING MEMBER # ANNUAL CREDENTIAL APPLICATION THE APPLICANT MUST HAVE A VALID 2017 IMSA COMPETITION MEMBERSHIP IN THE RESPECTIVE CLASSIFICATION AND BE AN ENTRANT, DRIVER OR LISTED ON AN ENTRANT S ROSTER TO OBTAIN AN ANNUAL CREDENTIAL FORM OF ANNUAL CREDENTIAL ENTRANT ANNUAL CREDENTIAL $ DRIVER ANNUAL CREDENTIAL $ CREW ANNUAL CREDENTIAL $ FIA INTERNATIONAL LETTER $ FIA LICENSE (DRIVER OR ENTRANT) $ USE 2016 PHOTO USE ENCLOSED PHOTO PHOTO VIA (registration@imsa.com) I have included a check for the membership/license and/or annual credential application fee(s) (made payable to: IMSA) Please charge the membership/license and or annual credential fee(s) to the credit card I have on file I would like to pay by a credit card that is not on file with IMSA* *If paying by credit card, once your application is received and approved by IMSA you will receive an with a link to a secured site where you can then make payment. Approval of an application is subject to IMSA s receipt of full payment within five (5) days from the date of the . Once payment is finalized you will be ed a detailed receipt of your transaction. Page 1 of 2

3 2017 ANNUAL MEMBERSHIP/CREDENTIAL AGREEMENT I am the applicant identified above and hereby apply for an IMSA 2017 Membership/License and Annual Credential (if selected) to permit me to participate in IMSA sanctioned competition races, qualifying, testing, practices and IMSA approved promoter test days (collectively referred to as Event(s) ) for the Series selected above and in the capacity of the Membership License Classification selected above. In consideration for such rights, I agree to the following: 1. RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT. I acknowledge that I have read, understood and voluntarily executed the 2017 IMSA RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT as part of this Membership/License and Annual Credential Application. 2. PERSONAL INJURY AND PROPERTY DAMAGE RELEASE. I hereby release and waive any and all claims pursuant to the RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT which I have executed as part of my IMSA Membership/License and Annual Credential Application. 3. SCOPE OF PERMISSION: I understand that an Annual Credential solely permits me to enter the track premises, the garage and the pit and pit lane area during the Events in the 2017 calendar season in accordance with the rules and procedures for access as they may be established by IMSA from time to time. IMSA may require that I carry certain identification, be accompanied by certain individuals, depart such areas, take certain actions, or refrain from taking certain actions, and I agree to abide by IMSA s directives in that regard. 4. IMSA RULE BOOK. I will make myself familiar with the current IMSA Rules, and I agree to abide by such rules as they may be amended from time to time. 5. NO TRANSFER. I understand that my Membership/License and Annual Credential (if selected) is personal to me, that I may not transfer or give it to any other person or entity, that any attempt to transfer, lend, or permit any other person or entity to use my Membership/License and/or Annual Credential may result in a fine imposed by IMSA of not less than Five Hundred Dollars ($500) and suspension or revocation of my Membership/License and/or Annual Credential. In addition, I agree to INDEMNIFY IMSA and all related parties for any damages arising in connection with such unauthorized transfer, lending, or use. 6. ADVERTISING AND PROMOTION RELEASE. IMSA, its duly authorized agents and assigns, may use, on a non-exclusive basis, my name, likeness and performance, including photographs, images and sounds of me and/or any vehicle(s) which I compete in Event(s), in any way, medium or material (including but not limited to broadcasts by and through television, cable television, radio, pay-per-view, closed circuit television, satellite signal, digital signal, film productions, audiotape productions, transmissions over the Internet, public and private online services authorized by IMSA, and sales and other commercial projects, and the like) for promoting, advertising, or reporting IMSA Events, or related telecast or programming before, during and after such Event and I do hereby relinquish to IMSA in perpetuity all rights thereto for such purpose. 7. BROADCAST AND OTHER RIGHTS. I acknowledge that IMSA exclusively and in perpetuity owns any and all rights to broadcast, transmit, film, tape, capture, overhear, photograph, collect or record by any means, process, medium or device (including but not limited to television, cable television, radio, pay-per-view, closed circuit television, satellite signal, digital signal, film productions, audiotape productions, transmissions over the Internet, public and private online services authorized by IMSA, sales and other commercial projects, and the like), whether or not currently in existence, all film, audio, video, and/or photographic, images, sounds and data (including but not limited to in-car audio, in-car video, in-car radio, other electronic transmissions between cars and crews, and timing and scoring information) arising from, during, or in connection with the Event(s) ( Work(s) ) and that IMSA is and shall be the sole owner of any and all intellectual property rights (including, but not limited to, patents, copyrights, trademarks, design rights, and other proprietary rights) worldwide in and to the Work(s) and in and to any other Work(s), copyrightable or otherwise created from the images, sounds and data arising from, during or in connection with the Event(s). In addition to the extent not already owned by IMSA, I hereby assign to IMSA exclusively and in perpetuity any and all rights set forth above. I represent and warrant that as of the date of this Agreement, I have not granted to any third party the rights described herein. I agree to take all steps reasonably necessary, and all steps requested by IMSA, to protect, perfect or effectuate IMSA s ownership or other interest in these rights. I agree not to take any action, nor cause others to take any action, nor enter into any third party agreement which would contravene, diminish, encroach or infringe upon these IMSA rights. 8. NO AGENCY OR EMPLOYEE RELATIONSHIP. I certify that I am not an agent or employee of IMSA and that I will not become an agent or employee of IMSA as a result of IMSA s approval of my application. I further certify that, with respect to any activities in which I engage in as a member of IMSA, I am either an independent contractor or an employee of another person or entity. Therefore, I assume all responsibility either by myself or my employer, for any charges, record keeping, premiums and taxes, if any, payable on any funds I may receive as a result of my activities as an IMSA member, including but not limited to, social security taxes, unemployment insurance taxes, workers compensation insurance, income taxes and withholding taxes. I understand that the receipt of this application and fee by IMSA, and/or the depositing of accompanying funds by IMSA, does not constitute approval of this application, and that all applications must be approved by IMSA Headquarters, One Daytona Blvd., Daytona Beach, Florida I warrant that all of the information provided herein is true and accurate. APPLICANT S LEGAL SIGNATURE: DATE: REMIT TO: IMSA Member Services International Motor Sports Association, LLC One Daytona Boulevard Daytona Beach, FL (USA) registration@imsa.com Page 2 of 2

4 2017 ANNUAL PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (Please Complete All Pages of Agreement) IN CONSIDERATION of my minor child ( the Minor ) being permitted to participate in any way in the EVENT(S) and/or being permitted to enter for any purpose any RESTRICTED AREA(S) (defined to be any area which requires special authorization, credentials or permission to enter or any area to which admission by the general public is restricted or prohibited), I agree: 1. I know the nature of the EVENT(S) and the Minor s experience and capabilities, and believe the Minor to be qualified to participate in the EVENT(S). I will inspect the premises, facilities, and equipment to be used or with which the Minor may come in contact and I will have the minor make such inspections. IF I OR THE MINOR BELIEVE ANYTHING IS UNSAFE, I WILL INSTRUCT THE MINOR TO IMMEDIATELY LEAVE THE RESTRICTED AREA AND REFUSE TO PARTICIPATE FURTHER IN THE EVENT(S). 2. I FULLY UNDERSTAND and will instruct the Minor that: (a) THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS AND participation in the Event(s) and/or entry into Restricted Areas INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ( RISKS ); (b) these Risks and dangers may be caused by the Minor s own actions, or inactions, the actions or inactions of others participating in the Event(s), the rules of the Event(s), and the negligent enforcement thereof, the condition, operation, design, and layout of the premises and equipment, or lack or insufficiency thereof, or THE NEGLIGENCE OF THE RELEASEES NAMED BELOW; (c) there may be OTHER RISKS NOT KNOWN TO ME or that are not readily foreseeable at this time; (d) THE SOCIAL AND ECONOMIC LOSSES and/or damages that could result from those Risks COULD BE SEVERE AND COULD PERMANENTLY CHANGE THE MINOR S FUTURE. 3. I consent to the Minor s participation in the Event(s) and/or entry into restricted areas and HEREBY ACCEPT AND ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES, COSTS AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH, EVEN IF CAUSES, IN WHOLE OR IN PART, BY THE NEGLIGENCE, INCLUDING NEGLIGENT RESCUE OPERATION OF THE RELEASEES NAMED BELOW. 4. I HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE THE promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, car owner, drivers, pit crews, rescue personnel, any persons in any Restricted Area, sponsors, advertisers, owners and lessees of premises used to conduct the Event(s), premises or event inspectors, surveyors, underwriters, consultants, and other persons or entities who give recommendations, directions or instructions or engage in risk evaluation or loss control activities regarding the premises or Event(s) and each of them, their directors, officers, agents and employees, all for the purposes herein referred to as RELEASEES, FROM ALL LIABILITY TO ME, THE MINOR, my AND THE MINOR S PERSONAL REPRESENTATIVES, assigns, heirs, and next of kin, FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON ACCOUNT OF ANY INJURY, including, but not limited to, death or damage to property, CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OR GROSS NEGLIGENCE OF THE RELEASEES. 5. If, despite this release, I, the Minor or anyone on the Minor s behalf makes a claim against any of the Releasees named above, I AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST THEY MAY INCUR DUE TO THE CLAIM MADE AGAINST ANY OF THE RELEASEES NAMED ABOVE, WHETHER THE CLAIM IS BASED ON THE NEGLIGENCE OF THE RELEASEES. 6. I sign this agreement on my own behalf and on behalf of the Minor as the authorized parent or guardian of the Minor. I HAVE READ THIS PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I AND/OR THE MINOR WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT. I HAVE READ THIS RELEASE Print Name of Minor Participant STATE OF COUNTY OF The foregoing instrument was acknowledged before me this day of, 20, by, who is ( ) personally known to me; or ( ) has produced the following type of identification:. (NOTARY SEAL/STAMP) Notary Public or Signature of Witnessing IMSA Official Printed Name Page 1 of 2

5 2017 ANNUAL MINOR S ASSUMPTION OF RISK ACKNOWLEDGMENT I have obtained my parent s consent to participate in the EVENT(S). I understand that I am assuming all of the risks if I get hurt during the EVENT(S) and I state the following: 1. My parent and I believe I am qualified to participate in the EVENT(S). I will inspect the premises and equipment and if, at any time, I feel anything to be unsafe, I will immediately leave and refuse to participate further in the EVENT(S). 2. I UNDERSTAND THAT THE ACTIVITIES OF THE EVENT ARE VERY DANGEROUS AND INVOLVE RISKS AND DANGERS OF MY BEING SERIOUSLY INJURED OR HURT, MY BEING PARALYZED OR KILLED. 3. I KNOW THAT THESE RISKS AND DANGERS MAY BE CAUSED BY my own actions or inactions, the actions or inactions of others participating in the event(s), the rules of the EVENT(S), the condition and layout of the premises and equipment, or THE NEGLIGENCE OF OTHERS, INCLUDING THOSE PERSONS RESPONSIBLE FOR CONDUCTING THE EVENT(S). 4. I ACCEPT AND ASSUME ALL SUCH RISKS OF BEING HURT OR KILLED, and want to be allowed to participate in the EVENT(S). I HAVE READ THE ABOVE ASSUMPTION OF RISK ACKNOWLEDGMENT, UNDERSTAND WHAT I HAVE READ, AND SIGN IT VOLUNTARILY. I HAVE READ THIS RELEASE Signature of Minor Participant Date Release Signed Print Name of Minor Participant Age of Minor Participant STATE OF COUNTY OF The foregoing instrument was acknowledged before me this day of, 20, by, who is ( ) personally known to me; or ( ) has produced the following type of identification:. (NOTARY SEAL/STAMP) Notary Public or Signature of Witnessing IMSA Official Printed Name Page 2 of 2

6 2017 ANNUAL FLORIDA PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF INTERNATIONAL MOTOR SPORTS ASSOCIATION, LLC, ITS PARENT, SUBSIDIARY, AND/OR AFFILIATED COMPANIES AND/OR THEIR EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, AND/OR AGENTS, USE REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD S RIGHT AND YOUR RIGHT TO RECOVER FROM INTERNATIONAL MOTOR SPORTS ASSOCIATION, LLC, ITS PARENT, SUBSIDIARY, AND/OR AFFILIATED COMPANIES AND/OR THEIR EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, AND/OR AGENTS IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND INTERNATIONAL MOTOR SPORTS ASSOCIATION, LLC, HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM. This acknowledgement and assumption of risk is written pursuant to and in compliance with Florida Statute and I HAVE READ THIS RELEASE Print Name of Minor Participant STATE OF COUNTY OF The foregoing instrument was acknowledged before me this day of, 20, by, who is ( ) personally known to me; or ( ) has produced the following type of identification:. (NOTARY SEAL/STAMP) Notary Public or Signature of Witnessing IMSA Official Printed Name Page 1 of 1

PRINTING INSTRUCTIONS

PRINTING INSTRUCTIONS All forms must be printed in COLOR on standard 8.5 x 11 paper. Black and white or illegible copies will NOT be accepted. 1. The MINOR VEST APPLICATION is a one (1) page form. 2. The