2022 NASCAR COMPETITION MEMBERSHIP AND LICENSE

APPLICANT MUST PRINT AND CAREFULLY COMPLETE ALL PAGES OF THIS APPLICATION

PAGE 1 OF 3NASCAR Advance Auto Parts Weekly Series

The acceptance of this application and fee by any NASCAR Ocial and the depositing of accompanying funds by NASCAR does not constitute approval of this application. Applications

may only be approved by NASCAR headquarters. This form is to be returned to NASCAR, One Daytona Boulevard, Daytona Beach, FL 32114. If the applicant is 19 years of age or younger, the applicant

must also submit a fully executed NASCAR Addendum A (Minor Release), available from NASCAR or www.NASCARMEMBERS.com. See also minimum age requirements in the NASCAR Rule Book.

2022 NASCAR MEMBERSHIP, LICENSE AND CREDENTIAL APPLICATION MEMBERSHIP AND LICENSE, IF APPROVED, EXPIRES DECEMBER 31, 2022

ONCE FORM IS COMPLETED, PLEASE PRINT, SIGN, SCAN, AND EMAIL BACK TO WEEKL[email protected]OM

“NASCAR” is NASCAR Event Management, LLC, its parents, subsidiaries and aliated companies.

2022 NASCAR COMPETITION MEMBERSHIP AND LICENSE APPLICATION

LOCAL

FOR OFFICIAL USE ONLY

RECEIVED PROCESSED

RIL.1.5.WCL

TYPE OF NASCAR COMPETITION MEMBERSHIP AND LICENSE BEING APPLIED FOR

Check below in which NASCAR Advance Auto Parts Weekly Series Division applicant plans to compete

IF THIS FORM IS NOT SUBMITTED ELECTRONICALLY, YOU WILL BE CHARGED FULL PRICE

NOTE: A driver with a NASCAR Learner’s Permit may only compete in a race car in Divisions where Local Track Rules allow. A track may specify, limit, or restrict Learner’s Permit

participation to certain divisions; disallow Learner’s Permit participation in some or all divisions; and/or limit 14-year olds with a Learner’s Permit to a certain division(s) and 15-year-

olds with a Learner’s Permit to a certain division(s). A driver with a NASCAR Learner’s Permit must not drive in any divisions that Local Track Rules do not allow for Learner’s Permits.

14 & 15 Years Old ONLY and MUST submit

certiﬁed copy of Birth Certiﬁcate

14 & 15 Years Old ONLY and MUST submit

certiﬁed copy of Birth Certiﬁcate

14 & 15 Years Old ONLY and MUST submit

certiﬁed copy of Birth Certiﬁcate

14 & 15 Years Old ONLY and MUST submit

certiﬁed copy of Birth Certiﬁcate

NOTE: IN ORDER TO RECEIVE THE ONLINE DISCOUNT,

THIS FORM MUST BE SUBMITTED TO WEEKLY@NASCAR.COM

OPTIONAL Ethnicity / Race (Select One)

NASCAR is committed to ensuring that people from all backgrounds feel welcome to participate in our sport. NASCAR continues to place an emphasis on diversity, an important element that is helping to grow our sport.

To gain a better understanding of the make-up of today¹s NASCAR membership, we ask that you ﬁll out the information in this panel. Supplying this information is completely voluntary and will have no bearing on the

acceptance or denial of your membership. Any information provided on this application and within this panel, will be kept conﬁdential and may only be used in accordance with the law.

White Black / African American Hispanic / Latino Asian Native Hawaiian / Other Paciﬁc Islander American Indian / Alaska Native Other

NASCAR Advance Auto Parts Weekly Series

Owner $225.00

FULL PRICE ONLINE DISCOUNT

Owner $200.00

Owner $125.00 Owner $100.00

Crew $125.00 Crew $100.00

Current Upgrade

Driver $225.00 Driver $200.00

Driver $125.00 Driver $100.00

Learner’s Permit $225.00 Learner’s Permit $200.00

Learner’s Permit $125.00 Learner’s Permit $100.00

DIVISION I (FEATURE)

CHARGER DIVISION

CREW LICENSE

UPGRADE

PERSONAL INFORMATION

Legal Last Name: Legal First Name: Sux: Middle Initial:

Racing Name:

(if dierent from above)

Last 5 digits of social security #: - Date of Birth: Gender: Male Female

Cell Phone: Applicant Email Address:

Mailing Address:

City: State: Zip:

Employer: Renewing NASCAR member?: Yes No Hometrack:

In Case Of Emergency Notify: Phone:

NASCAR Advance Auto Parts Weekly Series

Last Name: First Name: Middle Initial:

RIL.1.5.WCL

2022 NASCAR COMPETITION MEMBERSHIP AND LICENSE APPLICATION

LOCAL

SIGN HERE: DATE:

PAGE 2 OF 3

I am the applicant identiﬁed on the reverse side of this application. I hereby apply for a NASCAR membership, license and annual credential to participate

in NASCAR-sanctioned activities, including but not limited to competition races, testing and practices, collectively referred to as “Event(s)”, in the category

indicated on the reverse side, including access to restricted areas during Events.

NASCAR RULE BOOK. I will make myself familiar with the current NASCAR Rule Book, and I understand that the most current version of that Rule Book will be

online at the NASCAR Members website www.nascarmembers.com, and I agree to abide by such rules as they may be amended from time to time.

NO TRANSFER. I understand that my membership and license are personal to me, that I may not transfer or give it to any other person or entity, that any

attempt to transfer, lend, or permit any other person or entity to use it shall result in a ﬁne imposed by NASCAR of not less than Five Hundred Dollars ($500) and/or

suspension or termination of the membership and license. In addition, I will INDEMNIFY NASCAR and all related parties for any damages arising in connection with

such unauthorized transfer, lending or use.

NO AGENCY OR EMPLOYEE RELATIONSHIP. I certify that I am not an agent or employee of NASCAR and that I will not become an agent or employee

of NASCAR as a result of NASCAR’s approval of my application. I further certify that, with respect to any activities in which I engage as a member and licensee of

NASCAR, I am either an independent contractor or an employee of another person or entity. Therefore, I assume all responsibility either by myself or my employer, for

any charges, record keeping, premiums and taxes, if any, payable on any funds I may receive as a result of my activities as a NASCAR member and licensee, including

but not limited to, social security taxes, unemployment insurance taxes, workers compensation insurance, income taxes and withholding taxes.

ADVERTISING AND PROMOTION RELEASE. NASCAR, its duly authorized agents and assigns, may use, on a non-exclusive basis, unless otherwise provided

in the Driver and Car Owner Agreement, my name, likeness and performance, including photographs, images and sounds of me and/or any vehicle(s) with respect

to which I compete in NASCAR events, in any medium (including but not limited to print, broadcasts by and through television, cable television, radio, pay-per-view,

closed circuit television, satellite signal, digital signal, ﬁlm productions, audiotape productions, transmissions over the Internet, public and private online services

authorized by NASCAR, and sales and other commercial projects, and the like) for promoting, advertising, or reporting any NASCAR event, or related telecast or

programming, before, during and aer such event, and for the publicity, promotion and advertising of the NASCAR Hall of Fame, and I do hereby relinquish to NASCAR

in perpetuity all rights thereto for such purpose.

BROADCAST AND OTHER RIGHTS. I acknowledge that NASCAR exclusively and in perpetuity owns any and all rights to broadcast, transmit, ﬁlm, tape,

capture, overhear, photograph, collect or record by any means, process, medium or device (including but not limited to television, cable television, radio, pay-per-view,

closed circuit television, satellite signal, digital signal, ﬁlm productions, audiotape productions, transmissions over the Internet, public and private online services

authorized by NASCAR, sales and other commercial projects, and the like), whether or not currently in existence, all images, sounds and data (including but not limited

to in-car audio, in-car video, in-car radio, other electronic transmissions between cars and crews, and timing and scoring information) arising from or during any

NASCAR event and that NASCAR is and shall be the sole owner of any and all intellectual property rights (including, but not limited to, patents, copyrights, trademarks,

design rights, and other proprietary rights) worldwide in and to these works and in and to any other works, copyrightable or otherwise created from the images,

sounds and data arising from, during or in connection with any NASCAR event. In addition to the extent not already owned by NASCAR, I hereby assign to NASCAR

exclusively and in perpetuity any and all rights set forth above. I represent and warrant that as of the date of this Agreement, I have not granted to any third party the

rights described herein. I agree to take all steps reasonably necessary, and all steps requested by NASCAR, to protect, perfect or eectuate NASCAR’s ownership or

other interest in these rights. I agree not to take any action, nor cause others to take any action, nor enter into any third party agreement which would contravene,

diminish, encroach or infringe upon these NASCAR rights. I agree to allow any and all equipment relating to such audio, video, radio, electronic transmissions and

timing and scoring information, including, but not limited to, size, location, weight, and use thereof as determined by NASCAR, in the racing vehicle for each event. In

addition, I agree to the use of aerial drones above or around competition areas during Events related to video and audio transmissions.

I hereby enclose my annual membership and license dues for the year. I understand that the receipt of this membership application and fee by any NASCAR

Ocial, and/or the depositing of accompanying funds by NASCAR, does not constitute approval of this application, and that all applications must be approved

by NASCAR Headquarters, One Daytona Boulevard, Daytona Beach, Florida 32114. I warrant that all of the information provided herein is true and accurate.

NASCAR Advance Auto Parts Weekly Series

Last Name: First Name: Middle Initial:

RIL.1.5.WCL

2022 NASCAR COMPETITION MEMBERSHIP AND LICENSE APPLICATION

LOCAL

SIGN HERE: DATE:

PAGE 3 OF 3

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

THIS SECTION MUST BE CAREFULLY READ AND SIGNED BY THE APPLICANT IN CONSIDERATION OF BEING PERMITTED TO ENTER FOR

ANY PURPOSE ANY RESTRICTED AREA (deﬁned to be any area which requires special authorization, credentials or permission to enter or any area to which

admission by the general public is restricted or prohibited), or being permitted to compete, ociate, observe, work for, or for any purpose participate in any

way in the EVENT(S),THE UNDERSIGNED, for himself/herself, his/her personal representatives, heirs, and next of kin, acknowledges, agrees and represents

that he/she has, or will immediately upon entering any of such restricted areas and will continuously thereaer, inspect such restricted areas and all portions

thereof and which he/she enters and with which he/she comes in contact, and he/she does further warrant that his/her entry upon such restricted area or

areas and his/her participation, if any, in the EVENT(S) constitutes an acknowledgment that he/she has inspected such restricted areas and that he/she ﬁnds

and accepts the same as being safe and reasonably suited for the purposes of his/her use, and he/she further agrees and warrants that if, at any time, he/she

is in or about restricted areas and he/she feels anything to be unsafe, he/she will refuse to participate further in the EVENT(S), will immediately advise the

ocials of such unsafe situation and will leave the restricted areas and not return.

1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE THE PROMOTERS, PARTICIPANTS, RACING ASSOCIATION,

SANCTIONING ORGANIZATION OR ANY SUBDIVISION THEREOF, TRACK OPERATOR, TRACK OWNER, OFFICIALS, VEHICLE OWNERS, DRIVERS,

PIT CREWS, ANY PERSONS IN ANY RESTRICTED AREA, SPONSORS, ADVERTISERS, BROADCAST AND PRODUCTION ENTITIES, SUPPLIERS,

OWNERS AND LESSEES OF PREMISES USED TO CONDUCT THE EVENT(S), PREMISES OR EVENT INSPECTORS, SURVEYORS, INSURERS,

UNDERWRITERS, CONSULTANTS OR OTHER PERSONS OR ENTITIES WHO GIVE RECOMMENDATIONS, DIRECTIONS, OR INSTRUCTIONS OR

ENGAGE IN RISK EVALUATION OR LOSS CONTROL ACTIVITIES REGARDING THE PREMISES OR EVENT(S), AND EACH OF THEIR RESPECTIVE

PARENTS, SUBSIDIARIES, WHOLESALERS, AFFILIATED CORPORATIONS, AND EACH OF THEM, AND THE DIRECTORS, OFFICERS, AGENTS

AND EMPLOYERS OF EACH OF THEM, ALL FOR THE PURPOSES HEREIN REFERRED TO AS THE “RELEASEES”, FROM ALL LIABILITY to the

undersigned, his/her personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore on account

of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the “RELEASEES”, while the undersigned is

in or upon the restricted area, and/or competing, ociating in, observing, working for or for any purposes participating in the EVENT(S).

2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE “RELEASEES” and each of them from any loss, liability, damage, or

cost they may incur due to the presence of the undersigned in or upon the restricted area or in any way competing, ociating, observing, or working for, or

for any purpose participating in the EVENT(S) and whether caused by the negligence of the “RELEASEES”.

3. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE DUE TO THE NEGLIGENCE

OF “RELEASEES” while in or upon the restricted area and/or while competing, ociating, observing, or working for or for any purpose participating in the

EVENT(S). THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE

OPERATIONS OR PROCEDURES OF THE “RELEASEES”.

THE UNDERSIGNED expressly acknowledges and agrees that the activities of the EVENT(S) are very dangerous and involve the risk of serious injury

and/or death and/or property damage and that his/her heirs and next of kin have been so advised. THE UNDERSIGNED further expressly agrees that the

foregoing release, waiver, and indemnity agreement is to be governed by and construed in accordance with the laws of the State of Florida applicable to a

contract executed and performed in such State, without giving eect to the conﬂicts of laws principles thereof, and if any portion thereof is held invalid, it is

agreed that the balance shall, notwithstanding, continue in full legal force and eect.

All rights and obligations of this license, if granted, are speciﬁc to the individual applicant executing this membership and license application.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT,

and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.