Registration

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2020_mmt_membership_form.pdf
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2020 Registration

2020 Competitor membership and license applications expire on December 31, 2020. Each member will receive a discounted entry fee and receive points for year end Awards

* Indicates required field

DRIVER Name *

First

Last

Phone Number *

Birthdate

Email *

OWNER Name (if NOT Driver) *

First

Last

EMERGENCY CONTACT Name *

First

Last

Phone *

MONTH *

DAY *

YEAR *

Address *

Line 1

Line 2

City

State

Zip Code

Country

By submitting this I hereBy agree to aBide By all MMT and track rules and regulations. I agree to run MMT Sponsor decals in the designated area on the race car or forfeit 50% of the purse won. I hereby give MMT the right to use pictures or videos of myself, or my race car for promotional purposes. I agree to have all tax forms on file with MMT. If my car is found to be in rule infraction, I will return all prize money within 7 days. *

<-- I AGREE

WAIVER: I understand that racing is a dangerous activity and could result in Bodily injury and or death. I assume all risk associated with Being at a race venue. I, for myself and for anyone entitled to act on my Behalf, waive and release Midwest Modifieds Tour and the Race Track hosting the event along with their owners, promoters, officials, sponsors and their representatives for all claims or liabilities of any kind arising out of my participations in this event. *

<-- I UNDERSTAND

Submit

$100 annual fee required after submitting above

2020 Registration

2023 - MIDWEST MODIFIEDS TOUR