MEMBERSHIP # _______________ RECEIVED BY ________________ 


($100 for Modified, Sportsman, and Roadrunners.  $50 for Street Stocks)

Checks payable to: Big Diamond Speedway, P.O. Box 671, Minersville, PA 17954 

Applicants under the age of 17 must have a minor release form to participate.

Big Diamond Speedway, LLC reserves the right to reject any applicant.

IN CONSIDERATION of the acceptance of this membership application from Big Diamond Speedway, LLC for events held at BIG DIAMOND SPEEDWAY in 2016, I for myself, heirs, next of kin, personal representatives and assigns, FOREEVER RELEASE covenant not to bring suit or bring claim, REMISE or FOREVER DISCHARGE and AGREE TO HOLD HARMLESS and INDEMNITY the promoters presenting races or other events, the owners and the lessors; thus members, agents, employees, and servants all of them, of the premises at which these events are held, the participants, thereon and the owners, sponsors and manufacturers of all racing equipment used in an of these events, the officers, directors, agents and employees and servants of all of them, including officials and other participants, of and from all liability, claims action and of possible causes of action whatsoever but not limited to, including negligence of any of the foregoing, that may accrue to me or my heirs, next of kin and personal representative from every and any loss, damage or injury, including death, that may be sustained by my person and property while in or enroute into, ensuing and any events held before, during or after any event held by Big Diamond Speedway, LLC at Big Diamond Speedway. 

By signing this membership application form I acknowledge that I have read the entire form and understand its contents, risks involved and knowingly and voluntarily assume said risk. As additional considerations Big Diamond Speedway, LLC and Big Diamond Speedway has consent to use driver name and likeness, as well as racecar and race team likeness for promotional and souvenir materials. Each participant contained within the pits to be able to participate in events throughout 2016 must sign, pay, and return membership to Big Diamond Speedway, LLC. 

Applicant Name: ________________________________________

Applicant Address: ________________________________________

City: ________________________________________

State: _______ Zip Code: ___________ Applicant S.S. # _________-______-________ (drivers & owners only) 

Applicant Birth Date: _____/_______/_______ 

Phone: __________-_________-___________ 

Division: 358 Modifieds Sportsman Roadrunners Street Stocks (Circle One)

Owner Driver Official Crew Member (Circle One) 

Owner/Driver Affiliation ______________________________________ 

Car # ______________ 

Applicant’s Signature ____________________________________________ Date: ______________________ 

Witness ___________________________________________________________ Date: ______________________