Funktion Auto Group | Event Registration

Funktion Auto Group

Registration - Trackday Event: Shenandoah Circuit - Summit Point, WV

Event Location Event Date

* - Required field

Driver Information


	Name*		Email*
	Street*		City*
	State*		Zip*
	Home Phone *		Work Phone
	Emergency Contact		Emergency Phone

Car Information


	Car Make *		Car Model *
	Car Year *		Desired Car No.
	Drivers School *		No. of Previous Track Events:*

Payment Information


	Check or Money Order payable to FunKtion Auto Group. Fee: $625. Additional $25 for guests and spectators for Lunch but not driving. Additional Guests Mail your check to: FunKtion Auto. 11103 Farm Rd. Great Falls, VA 22066

	Credit Card Credit Card Number
	Expiration Date Security Number on Back of CC

	RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT - Covering FunKtion Auto, LLC. In consideration of being permitted to enter for any purpose any RESTRICTED AREA (herein defined as including but not limited to the racing surface, pit areas, infield, approach area, and all walkways, concessions and other areas appurtenant to any area where any activity related to the event shall take place), or being permitted to compete, officiate, observe, work for, or for any purpose participate in any way in the event, THE UNDERSIGNED, for himself his personal representatives, heirs, and next of kin, acknowledges, agrees and represents that he has, or will immediately upon entering any of such restricted areas, and will continuously thereafter, inspect such restricted areas and all portions thereof which he enters and with which he comes in contact, and he does further warrant that his entry upon such restricted area or areas and his participation; if any, in the event constitutes an acknowledgment that he has inspected such restricted area and that he finds and accepts the same as being safe and reasonably suited for the purposes of his use, and his further agrees and warrants that if, at any time, he is in or about restricted areas and he feels anything to be unsafe, he will immediately advise the officials of such and will leave the restricted areas: HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the promoter, participants, racing association, sanctioning organization or any subdivision thereof, track operator, track owner, officials, car owners, drivers, pit crews, any persons in any restricted area, promoters, sponsors, advertisers, owners and lessees of premises used to conduct the event and each of them, their officers and employees, all for the purposes herein referred to as releasee; from all liability to the undersigned, his 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 leasees or otherwise while the undersigned is in or upon the restricted area, and/or, competing, officiating in, observing, working for, or for any purpose participating in the vent: HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasee 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, officiating, observing, or working for, or for any purpose participating in the event and whether caused by the negligence of the releasee or otherwise. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY DEATH OR PROPERTY DAMAGE due to the negligence of releasee or otherwise while in or upon the restricted area and/or while competing, officiating, observing, or working for or for any purpose participating in the event. THE UNDERSIGNED expressly acknowledges and agrees that the activities of the event are very dangerous and involve the risk of serious injury and/or death and/or property damage. THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
	I have read and accept the Release and Waiver Agreement *

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