Modifieds of Mayhem Music City 50

Car Number *

Name * First Last

Drivers Email *

Emergency Contact * First Last

Social Security # / Tax ID

SS# or Tax ID for person receiving prize money.

Car Owner/Person Receiving Prize Money If Not The Driver First Last

If someone other than the driver will receive purse money please complete all information.

Email

Crew Chief/Primary Team Contact * First Last

This is the person who will receive event updates by text message and email. Primarily at track during the event.

Primary Contact Email *

Sponsors (Please include atleast two) *

Comments

ENTRY AND ADVERTISING RELEASE:

By submission of this entry all parties understand and agree that their names and likeness may be used by Nashville Fairgrounds Speedway (NFS) ,The Modifieds of Mayhem Tour (MoM) and authorized agents in any way, medium, or material to promote, advertise, record, or report this event before, during, and after the event, and do hereby relinquish all rights hereto for these purposes. The undersigned understands and agrees that all decisions made by MMS Officials will be final and without recourse. The undersigned further waives any and all rights for themselves, their agents and assigns, to institute any action, suits or proceedings, whether at law, or any other action against MMS , MoM and its officers, directors, agents and employees for any and all, manner or actions, cause and causes of actions, suits, damages, and claims that the undersigned and their heirs, successors, assignees may have now, or at any time in the future may have, arising in any manner from MMS, MoM promoted events, excepting MMS, MoM obligation to pay purses, bonuses, and awards as set forth in the Official entry