IWK 250 Competitor Info / Pro Stock - Riverside International Speedway

Car Information

Car Number *

Car Make/ Model *

Home Series/ Track *

Maritime Pro Stock Tour
Super Late Model Series
Other

Will be used to determine provisional eligibility, if required.

If Other, please specify Home Track/Series... *

Primary Sponsor *

Associate Sponsors *

list in order of importance for recognition, separate with commas

Driver Information

First Name *

Last Name *

Address (Driver) *

Address Line 1

City

State / Province / Region

Postal Code

Country

Daytime Phone Number (Driver) *

Cell Phone Number (Driver) *

Email (Driver) *

Email

Confirm Email

Home Track/ Series *

Racing Accomplishments/ Experience *

Car Owner Information

Name is required; the rest only if different than the driver.

Car Owner Name *

First

Middle

Last

Address (Car Owner)

Address Line 1

City

State / Province / Region

Postal Code

Country

Daytime Phone Number (Car Owner)

Cheque Payable To *

Car Owner
Driver
Other

Single Line Text

IWK 250 Entry Fee Payment

Entry Fee *

Price: $300.00

Includes five July 15 pit passes. eWaiver required and a release needs to be signed by each person at the gate prior to pit entry; pit area is restricted to those 18 and older; HST included.

Upgrade Pit Passes Included With Entry Fee to Weekend Pit Passes *

No
Yes ($150.00)

A weekend pit pass includes admission to the Tailgate Party on July 13 plus pit admission July 14 and 15 (does NOT include pit admission for July 13 practice session). Upgrade MUST be purchased with this Entry Form.

Total *

$0.00

total amount shown will be charged to credit card provided below; HST included

Stripe Credit Card *

Card

Name on Card

Email Address Where Receipt for Payment & eTickets Should be Sent *

Email

Confirm Email

Entry & Advertising Release

By submitting this form it is understood and agreed by the applicant that the driver's name and likeness may be used by Riverside International Speedway (hereafter referred to as 'RIS') to promote this event. RIS reserves the right to decline entry of any participant for safety or other reasons. The applicant also understands and agrees that all decisions made by RIS or designated representatives shall be final and without recourse. In the event that the applicant is disqualified as a result of racing efforts, it shall be without restitution of any part of the fee paid in connection with this entry and further, the applicant waives any and all rights or claims to any purse or bonus money. The applicant further waives any and all rights for themselves, their agents and assigns, to institute any action, suits or proceeding, whether at law, or any other action against RIS and its officers, directors, agents and employees for any and all, manner or action and actions, cause and causes of actions, suits, damages, and claims that the applicant and their heirs, successors, assigns may have not, or at any time in the future may have, arising in any manner of RIS promoted events. The applicant understands and agrees that this release constitutes a waiver of any and all claims for personal injury, breach of contract, and any other loss of damage except as expressly provided herein. Furthermore, the applicant acknowledges the support of racing fans, sponsors, the media, and the Promoter and agree they will compete on a best effort basis; and agree to notify RIS if they will not be competing in this event, realizing time is of the essence in this matter.

Acceptance

Minor Agreement *

I understand and agree that anyone entering the infield with my team will be 18 years of age or older, or have a valid Minor Access to Pit Card issued by RIS (available at www.riversidespeedway.ca/for racers, application MUST be submitted at least seven days prior to desired infield entry).

Terms *

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SUBMITTING THIS AGREEMENT I AM WAIVING CERTAIN SUBSTANTIAL LEGAL RIGHTS WHICH I AND MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES. I SUBMIT THIS DOCUMENT VOLUNTARILY AND WITHOUT INDUCEMENT.

Entry Form Submitted By *

First

Middle

Last

herein known as the 'applicant'; must be 18 years of age or older and the driver or an authorized legal representative

Complete Entry

This Entry Form and payment will be processed when "Submit' is clicked - please wait for thank-you message or notification of error - if there is an error it will be indicated by the field in question - fix and resubmit - once form has been processed you will receive two emails, 1) a copy of your entry and 2) a receipt for payment

Contact Info