2008 License App

First Name:	Last Name:
Address:
City:	State: Zip:
Phone#:	E-Mail:
Emergency Contact Information
Name:
Phone#:
Have you ever held a roadracing license? Yes No
Organization:

Requested Race Number:

Choice #1

Choice #2

Choice #3

I have read this application in it’s entirety and stipulate, under the penalty of perjury, that all statistical information set forth herein by me is true and accurate and complete.
In consideration for granting me a competition license by the Southeastern Mini Roadracing Association, LLC (hereafter referred to as SEMRA), and in consideration of the promotion and operation of roadrace events by SEMRA, and in consideration of granting of permission to enter, use and remain on the track facilities and/or premises at which these events take place by the owners and representatives thereof, I hereby, for myself, my heirs, personal representatives and assigns, release, discharge, and agree to hold blameless and indemnify SEMRA, it’s representatives, the owners and representatives of the aforementioned track facilities and/or premises, as well as directors, officers, agents, employees and/or members of all of them and from any liability, loss, claims, demands and possible causes of action that may otherwise accrue from any loss, damage, injury (including death) to my person and property, in any way a result from, or arising in connection with, or related to any event, and whether arising, while engaged in competition or in practice or preparation thereof, while upon entering or departing from said track facilities and or premises, from any cause whatsoever including without limitation, the failure of anyone to enforce rules or regulations, failure to make inspections, of the negligence of other persons.  I understand that motorcycle racing competition can constitute a hazardous activity and that by reason of my application for a SEMRA roadrace license and /or participation in or presence at any competition event, I am assuming all risks and hazards related thereto.
I agree that SEMRA may use my name and likeness, including pictures of my racing equipment and pictures taken at any event, for the purpose of media and promotion.  I agree to abide by SEMRA rules and respect the authority of the race officials and personnel at all events.
I hereby confirm, consent and agree to the foregoing.

Date of Birth

If you are under 18 you legally can't agree so you must have a parent or guardian sign the printable version and mail it in.

SEMRA License Fee $40.00 ($10.00 for additional minor children)
Payment Options:

1 - Paypal funds to: semra46@bellsouth.net

You do not need a PayPal account to send money.

*Single day license is valid for one event per season per person, $30 balance will be required at second attended event.

2 - Mail check or money order made out to: SEMRA

Southeastern Mini Roadracing Association, LLC
c/o John P. Halsey
3002 Earls Bridge Rd.
Easley, SC 29640

1 - Paypal funds to: semra46@bellsouth.net

SEMRA
Single Day Competition License*
$10

2008 SEMRA
Competition License

$40

2008 Adult
+1 minor Competition License
$50

2008 Adult
+2 minor
Compitition Licenses
$60

2 - Mail check or money order made out to: SEMRA

Must be postmarked 10 days prior to event date. No exceptions. Dishonored checks will incur a $25.00 fee and be posted at registration desk.

Send mail to webmaster@semra.org with questions or comments about this web site.
Copyright © 2008 Southeasten Mini Roadracing Association, LLC
Last modified: 02/26/2008

1 - Paypal funds to: semra46@bellsouth.net

SEMRA Single Day Competition License*$10

2008 SEMRA Competition License $40

2008 Adult+1 minor Competition License$50

2008 Adult+2 minor Compitition Licenses$60

2 - Mail check or money order made out to: SEMRA

Must be postmarked 10 days prior to event date. No exceptions. Dishonored checks will incur a $25.00 fee and be posted at registration desk.

Send mail to webmaster@semra.org with questions or comments about this web site. Copyright © 2008 Southeasten Mini Roadracing Association, LLC Last modified: 02/26/2008

SEMRA
Single Day Competition License*
$10

2008 SEMRA
Competition License

$40

2008 Adult
+1 minor Competition License
$50

2008 Adult
+2 minor
Compitition Licenses
$60

Send mail to webmaster@semra.org with questions or comments about this web site.
Copyright © 2008 Southeasten Mini Roadracing Association, LLC
Last modified: 02/26/2008