Entry, Inspection &
Classification Form
April 2013 Meet

Vehicle #:	27
Class:	A/FRMR
Date :	Sat 04-27-2013

ENTRY NAME:	Prime Speed Racing
PRIMARY RIDER/DRIVER NAME:	Steven Quick
Rider/Driver #1:	Bob Quick - #27A	License Cat. ___	Rookie
Rider/Driver #2:	Pete Vee Quick - #27B	License Cat. ___	Rookie
Rider/Driver #3:		License Cat. ___	Rookie
Rider/Driver #4:		License Cat. ___	Rookie

ENGINE year & type:	Olds	CID/cc:	460	No. Cyl:	8
BODY/Frame year & model:	1927 Ford			Color:
	Fuel: fuel				Blown:
* RELEASE * I, the undersigned, in consideration of the timing facility and privileges extended to me, hereby agree in behalf of myself, my successors and assigns, that I shall accept full and entire responsibilities for any and all consequences, injuries or otherwise that may arise from the operation of my vehicle operated by me in any race, timing event or other contest or event conducted by the East Coast Timing Association LLC, and/or its members; and I hereby, in behalf of myself, my successors and assigns, release, covenant not to sue, and waive any and all legal liability and/or cause of action that I may now have or thereafter acquire against the East Coast Timing Association LLC, or any of its members or anyone employed or acting as timers, judges or any other capacity in conducting such races and/or timing events at Wilmington, OH or any other location.

____________________ Primary Rider/Driver Signature	____________________ Alter. Rider/Driver Signature	____________________ Alter. Rider/Driver Signature
	____________________ Alter. Rider/Driver Signature	____________________ Alter. Rider/Driver Signature

***CARS***  UNDER 135 MPH INSPECTION
	OK	NA		OK	NA
State Drivers License	___	___	Tire Condition	___	___
Long Sleeves & Pants	___	___	Brakes Operable	___	___
Helmet-Snell 2005	___	___	Front End & Steering	___	___
Seat & Shoulder Belt	___	___	Fuel Lines, Tight	___	___

ALL CARS Inspected to Max Speed
135MPH	____	RED
150MPH	____	YELLOW
175MPH	____	GREEN
175+MPH	____	Open

INSPECTORS’ SIGNATURES
(All Racers)	Inspector’s Signature: ________________________	Date: ____________
(175+ MPH New Bikes) (200+ MPH New Cars)	Inspector’s Signature: ________________________	Date: ____________
(200+ MPH Bikes) (250+ MPH Cars)	Inspector’s Signature: ________________________	Date: ____________

ECTA USE  ONLY

1. Day______ Time _______ Class ___________ Driver/Rider ________________ Fee $50___  Cash / Check / CC    Initials ___

2. Day______ Time _______ Class ___________ Driver/Rider ________________ Fee $25___  Cash / Check / CC    Initials ___

3. Day______ Time _______ Class ___________ Driver/Rider ________________ Fee $25___  Cash / Check / CC    Initials ___

4. Day______ Time _______ Class ___________ Driver/Rider ________________ Fee $25___  Cash / Check / CC    Initials ___

o Pre-Entry $200     o Track Entry $200    Membership o $50 o $25         Total  Pd:_______      Cash / Check / CC    Initials ___