Membership Application

Membership Application
Full Name*

First NameLast Name
E-mail*
example@example.com
Birth Date*

MonthDayYear
Phone Number*
Please enter a valid phone number.
Address Line 1*
Address Line 2
State*
City*
Zip Code *
Country*
DL Number*
DL/State*
Membership Requested*

FIA CAR TRACK :: Eagle - $5,000 Initiation / $350 MonthlyFIA CAR TRACK :: Platinum - $10,000 Initiation / $650 MonthlyOFF ROAD :: Eagle -$2,500 Initiation / $250 Monthly
What will be your primary Vehicle on Track?

Sports CarOpen Wheel CarMotorcycleSide by Side on Off RoadTruck on Off RoadRally Car on Off Road
Promo Code
This Selection does not commit the applicant or ECR. ECR will process the application and if it is approved the applicant will, in turn, need to approve and sign the contract.
How Did you decide to Join?*

ECR StaffExisting MemberMarketing / Social MediaOther - Please fill in below
Existing Member

First NameLast Name
Other (Enter any Name or Code Here)
Additional Comments
Emergency Contact - Medical
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship*
Medical - Additional Info
Any Conditions / Allergies that we should be aware of
Payment Information - Initiation

Once your application is approved, you will receive a contract to review. When you sign and approved it we will send an invoice for the initiation fee
Payment Information - Monthly Dues

We will contact you to establish a preferred method for payment of monthly dues
WARNING

Motorsports activities can be dangerous. These activities can result in injury or even death. By submitting this form you signify that you understand and assume these risks. Members and their guests will be required to sign waivers to indemnify Eagles Canyon Raceway, all of its employees, and all other participants related to Eagles Canyon Raceway.
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Membership Application

Emergency Contact - Medical

Payment Information - Initiation

Payment Information - Monthly Dues