MEMBERSHIP APPLICATION

Please complete the AQMA membership application below in full to finalize your membership. If you prefer a paper submission, you can find that here: Printable PDF Application

Parent/Legal Guardian (1) First Name

Parent/Guardian (1) Last Name

Email

Phone

Address

Parent/Guardian (2) First Name

Parent/Guardian (2) Last Name

Email

Phone

Address if different than above

Driver 1: First and Last Name

Driver 1: Date of Birth

Driver 1: Gender

Driver 2: First and Last Name

Driver 2: Date of Birth

Driver 2: Gender

Driver 3: First and Last Name

Driver : Date of Birth

Driver 3: Gender

Non Driver Child (If none, answer N/A)

Non Driver Child

I/We understand for the purpose of this agreement American Quarter Midget Association will be referred to as AQMA and Nascar Youth Series will be referred to as NYS.

I/We acknowldege all Nascar Youth Series and AQMA safety rules must be adhered to.

I/We understand there must be two adults at the track at all times in case of emergency.

I/We understand only current AQMA/NYS members may use the facility.

I/We understand no one is to drive a car without being a NYS member in good standing.

I/We understand the lock combination/key must remain in my/our possession at all times and shall not be shared with any other person. I/We will advise anyone to contact the club secretary for necessary codes for track access.

I/We understand a fire extinguisher must be trackside at all times while a car is on track. The track fire extinguisher is located in the locked box in the tech area. Lock combination/key will be provided upon membership completion.

I/We understand when finished for the day, the fire extinguisher must be returned to the box and locked.

I/We understand no one is to be in the pit area (on chute or hot chute) unless they are a driver or handler with a valid membership. Handlers are to be no less than 16 years old.

I/We understand no motorized scooters, bikes, motorcycles, ATV's, autos, dirt or street karts are allowed in any area of the racing surface, staging lanes, or hot chute.

I/We will be considerate of those waiting to practice and ensure everyone get equal time on the track.

I/We will repair any wall damage as necessary or will notify the club president or email info@aqma.us if the walls need extensive repair.

I/We understand no tires of any kind shall be left at the track or placed in the club waste receptacles. I/We are responsible for disposing of tires properly. I/We will also clean up all tire shavings and dispose in waste receptables.

I/We will clean up all trash and dispose of it properly.

I/We understand all pets must be on a leash at all times and, I/We will clean up after our pets.

I/We understand the track gate must be locked upon leaving the facility. Parking lot gates are to be left open unless otherwise noted.

I/We understand all Prairie City SVRA rules and regulation must be followed. It is my/our responsibility to know these regulations, this is a state park.

I/We understand the track will be closed for practice on race dates and training dates.

I/We will abide by the Prairie City SVRA hours of operation and it is my/our responsibility to know the park's operating hours.

I/We hereby grant permission to AQMA and its representatives to take and use photographs, videos and/or digital images of my child during the current or future season for use in AQMA promotions.

I/We understand videos/images may be included in, but not limited to printed/electronic publications, websites, or other electronic communications, and my child's name and identity may be revealed in descriptive text/commentary with images.

I/We authorize the use of images/videos without prior approval or compensation to me/us. All negatives, prints, digital reproductions shall be the property of AQMA and its representatives.

I/We hereby tender my/our application for membership in the American Quarter Midget Association. I/We will obey the laws of the club and Prairie City SVRA, promote it's interests, and further it's principles. It is understood as a member, I/We are expected to bear my/our share of the Club's program and I/We acknowledge the mandatory work requirements. By signing below I/We agree to follow all the rules stated in this membership agreement.

Parent/Legal Guardian (1) Signature