URA Registration Form

URA Yearly License

Includes License For All Sanctioned Tracks
Please fill-up the form below to register to the season:
Florence Motor SpeedwaySouthern National Motorsports Park
Driver Information
Driver's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person*

First NameLast Name
Emergency Person Phone Number*

Area CodePhone Number
Relationship to Emergency Contact Person*
Drivers License # (This will act as your URA License)*
Car Details
Make
Chassis
Division
Car Number
Registration Payment
Release & Agreement
Click on the links below to read the full releases & agreements.

ASSUMPTION OF RISK & INDEMNITY AGREEMENT

ADDITIONAL RULES & RELEASES
I AGREE TO THE WAIVER OF LIABILITY - ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.I AGREE TO THE ABOVE ADDITIONAL RULES AND RELEASES.
Driver's Signature*

Clear
Date Signed

MonthDayYear
Date
My Products
prevnext( X )
LMSC Driver License$150.00

Driver License$100.00
All Other Divisions

Crew Member$75.00
All Crew Members

Total $0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

URA Yearly License