COPY AND PASTE THIS APPLICATION TO A NEW PAGE THEN PRINT IT OUT AND MAIL IT TO ADDRESS LISTED BELOW.
NBRA
National Boat Racing Association
200__ Membership Application
Mail to: Mardell Swartz
1839 S. 12th St.
Quincy, IL 62301
Membership Fees FOR OFFICIAL USE ONLY
Racing Member $80.00 ______
Novice $35.00 ______
Non-Racing & Official $30.00 ______
One Time Racing $45.00 ______
To be eligible to register boats and participate in racing, every driver must be a racing member of National Boat Racing Association
Name:_____________________________________________________________
(Please Print)
Address: __________________________________________________________ Street City State Zip Code
Home Phone No: ______________________________ Hours:__________
Work/Cell Phone No: ___________________________ Hours:__________
E-mail: ________________________________Date of Birth: ______/____/______
Number of years racing: _____ Rookie: _____ Boat No: _______
Team Colors:_______________
Local Club: __________________________________________________________________
Classes you anticipate participation in: _________________________________________________
Family & Crew Names: _____________________________________________________________
Release and Indemnity
(Must be read and signed by all participants)
Racing membership in the National Boat Racing Association (NBRA) includes the following to each individual member:
1. Assignment of racing number
2. Right to participate in sanction events, subject to NBRA regulations
3. NBRA’s News periodical, racing notices and rule book
4. Full voting rights as outlined in NBRA’s Rule Book
One time racing membership in NBRA includes the following to each individual member:
1. Right to participate in one day only, thereafter will have to pay full membership
2. No voting rights
Non –Racing and Official membership in NBRA includes the following to each individual member:
1. NBRA’s News Periodical, race notices and NBRA Rule Book
2. Voting rights as outlined in NBRA’s Rule Book
OVER
(Remove Lower Portion for Member’s Receipt)
Pay to the Order of ___________________________________________ For _______________________ NBRA ___________Membership
Print Member’s Name) (Year)
In the Amount of $ ________ Date ____/_____/________ Club Representative Signature______________________
Member must maintain this receipt until current membership card is received
IN CONSIDERATION of being granted the above membership in the National Boat Racing Association I the UNDERSIGNED, for myself, my personal representatives, assigns, heirs and next to kin, DO:
a. HEREBY AGREE TO ASSUME ALL RESPONSIBILITY AND LIABILITY FOR ALL ACTS OR ACTIVITIES, of myself, my drivers, assistants and crew and for any damage or injury that may be caused by or to any of all of us or by or to our boat, motor, properties, or possession.
b. HEREBY RELEASE, WAIVE, DISCHARGE, AND CONENANT NOT TO SUE THE NATIONAL BOAT RACING ASSOCIATION, INCLUDING ALL ITS COPORATE, ELECTED AND APPOINTED OFFICIALS. ALL MEMBERS OF COMMITTEES, REFEREES AND OFFICERS, AGENTS, AND EMPLOYEES OF THE FOREGOING, all hereinafter referred to as “NBRA Et Al” from or for any and all liability to me, my personal representative, assigns, heir and next of kin for all loss or damage to property, which in any way grows out or results directly or indirectly from an NBRA activity or part thereof, or in connection with any vessel, dock, float, barge, equipment or facility provided or used, whether or not same may be operated or controlled by “NBRA Et Al” and whether arising prior to, during or following such NBRA activity; and whether any such claim may be based upon alleged active or passive negligence or otherwise, or participation in the wrong, or upon any alleged breach of statutory duty or obligation; and
c. HEREBY AGREE TO INDEMNITY AND REIMBURSE AND HOLD HARMLESS “NBRA Et Al” or any of them for any loss, damage or injury, that “NBRA Et Al” may sustain or for expenses advance, caused by me, my personal representatives, assigns, heirs and/or next of kin, by violating this covenant not to sue. I EXPRESSLY AGREE that the forgoing RELEASE, ASSUMPTION OR RISK, MUTUAL RELEASE WAIVER, COVENANT NOT TO SUE, SAVE AND HOLD HARMLESS AND IDEMNITY CONTRACT is intended to be as broad and all inclusive as is permitted by law and that if any portion thereof is held invalid, or unenforceable, I agree that the balance shall not withstanding, continue in full legal force and effect.
I WARRANT THAT I HAVE READ AND UNDERSTAND THIS RELEASE AGREEMENT, IN WITNESS THEREOF, I have hereunto set my hand the day, month and year written below: This agreement is governed pursuant to the laws of the state of Oklahoma.
MEDICAL AND INSURANCE INFORMATION
Do you have medical/health coverage? ______________________________________________________
If so, Company __________________________________________________________________
Employer __________________________________________________________________
Occupation __________________________________________________________________
Allergies or Medical History that we need to be aware of? _______________________________________
__________________________________________________________________
Signed: ________________________________________Date:____/____/_______
Witness: _______________________________________Date:____/____/_______
SPECIAL RELEASE FOR MINORS
(If the owner or driver is under 18 years of age the parents or guardians must execute in addition the following waiver): The undersigned parents and/or guardians for and in consideration of the above noted mutual covenants securing to his ward, and intending to be legally bound, by this release, do hereby agree to all provisions contained in the above RELEASE AGREEMENT and waive all rights and claims that might accrue through relationship to the above applicant and/or owner or owners or drivers and do adopt same as it repeated herein.
Signed: ________________________________________Date:____/____/_______
