More track time for less money!

MEMBERSHIP APPLICATION

I hereby apply for Membership in SAFE Motorsports and agree to abide by the bylaws of the Club and the Rules of Conduct
on course.  I certify that I am age 21 or older and I have had previous training and experience driving a car at high
speed with other cars on a road course, as required for approval to participate in events held by SAFE Motorsports, Inc.
I acknowledge that I will be participating in a high speed driving activity and that the nature of such activity is very
dangerous.  I assume all the risks inherent and incidental to this type of activity. I understand that I will be driving on
course at high speed at the same time with other cars, along with other drivers who have varying levels of high speed
training and experience.

NAME________________________________________________   DATE OF BIRTH_______________

MAILING
ADDRESS_______________________________________________________________________

CITY________________________________________________STATE___________ZIP_______

TELEPHONE:          Day____________________           Eve______________________________

Make/model of Car__________________Yr______      Street Car ? _____or Competition Car? ______

Track training and experience: (List any professional Driver Schools, Clubs
with high speed schooling events, any current or past Competition Licenses
held.  Include number of years of experience.  Attach a copy of any schooling
completion certificate or current competition license (if possible).
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

I certify that the above information is accurate and true and can be verified
upon request.

Signature_______________________________________________________Date__________

COMPLETE THIS SECTION IF YOU ARE APPLYING FOR A "FAMILY MEMBERSHIP":
For qualified spouse or same household family member who will be driving on
course.  Use back side of sheet if needed.

NAME________________________________________________     DATE  OF  BIRTH _________

TRACK TRAINING AND
EXPERIENCE_________________________________________________________________

Family member
signature_____________________________________________Date____________
Membership Fees:    $50 Single            $65 Family                                     
                                   Your Membership will run for one year from the date of joining.

Make your check payable to:  SAFE Motorsports Inc.
Mail to:    Phil Steinberg, Registrar
               837 SW 56th Street
               Cape Coral, FL  33914