MCQMRC Visiting Driver Profile Sheet 23

Drivers

First Name Last Name

Car Number

Age

Home Track

Class(es) Currently Running

Future Racing Plans

Date of Birth

Additional Information if needed

I Give/Do Not Give Permission

I GIVE the club permission to post racing photos of my driver on web siteI DO NOT give the club permission to post racing of my driver on web siteI GIVE the club permission to post head shot on drivers profile pageI DO NOT give the club permission to post head shot on drivers profile page JUST profile informationI GIVE the club permission to post my driers race results weekly during racing season on the web site & newspapers (name, car number, class & possible photo(s)I DO NOT give the club permission to post my driers race results weekly during racing season on the web site & newspapers (name, car number, class & possible photo(s)I GIVE the club permission to use my drivers information for promotional items to promote 1/4 midget racingI DO NOT give the club permission to use my drivers information for promotional items to promote 1/4 midget racing

I, the undersigned, hear by grant the MCQMRC (referred to as "The Club") permission to place on internet all provided information about and or photos if you choose to add to web site.

MCQMRC Visitor Driver Profile Sheet 23