Membership

2024 Membership Application

Renewal of current members $100

First Time application for new members $100 (Copy of Birth Certificate Required.)

1st Alternate Handler $25

2nd Alternate Handler $25

Optional $25 donation to VSQMA to help bring our families a better racing experience.

Driver Information:

Driver 1 Name *

Date of Birth *

Age *

Driver 2 Name

Date of Birth

Age

Driver 3 Name

Date of Birth

Age

Parent Information:
If the address is the same, you may leave one blank. Club information is usually sent by e-mail so if you both would

like to receive the information please list both.

Mother's Name

Father's Name

Address

City, State, Zip Code

E-Mail

All forms of motorsports racing involve risk and the possibility of serious injury or death. It is the responsibility of the parents and family to evaluate these risks and determine at all times whether the VSQMA track facility or events are suitable for use or participation. It is the responsibility of the entire membership of VSQMA to maintain and operate the facility both individually, collectively and through an elected volunteer Board of Directors. Both parents of minor children must sign this application as well as the supplemental form titled, "Parental Consent, Release and Waiver of Liability, Assumption of Risk, Covenant not to Sue and Indemnity Agreement, "Prior to submitting the membership application.

I have Read the above paragraph and agree to be bound by it's terms.

Signature

(Printed Name)

Mother of minor participant

Date

Farther of minor participant

Date

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