Local Race Request Form

Local Race City *To be used for FEAASBD Race Week *

State/Province/Country*

Region*

Local Race Date*

MonthDayYear

If you are unsure of your date please add a date that you think the race will be held. If the date does change please contact our office so we have the correct information.

Trial Run Date (If you have more than one trial run date please list in additional races below)

MonthDayYear

Rain Date

MonthDayYear

Dates of additional races, fun runs, events, fundraisers, etc. to be insured.

Divisions *

Stock (8 Car Min.)Super Stock (8 Car Min.)Masters (4 Car Min.)

Trackside Address/Location*

Race to be run on*

City StreetPermanent TrackPrivate StreetOther

Do you use ramps?*

YesNo

If you use ramps how tall and long are they?

Track Length*

Run Out Length*

Types of Barriers Used *

Along Track and Run Out

Entry Fee*

NoOther

Local Race Director*

First NameLast Name

How many years have they been Director? Including the year you are applying for*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone Number*

Area CodePhone Number

Assistant Director/Co-Director*

First NameLast Name

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone Number*

Area CodePhone Number

Local Race City Organization*

Organization Name

State/Province/Country*

How many years has this local been held? Including the year you are applying for*

President

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

Vice President

Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Secretary

Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Treasurer

Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Website Manager

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

List any additional Board and Committee Members below. You must click save after each member is entered into the text boxes.

Licensee - *

Organization signing the License Agreement and responsible for compliance with terms and payment of license fee. This name and address will also be listed as the ceritficate holder for insuance.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Please Specify*

For ProfitNon-Profit

List any specific certificate requirements:*

List all additional insured: Individuals can not be listed.*

I need a separate certificate of liability issued to:

When requesting an additional certificate holders you must include the name of organization and the organizations address*

ex: City of Jamestown, New York, PO Box 123, Jamestown, NY 00000

I need an endorsement

Terms and Conditions

License Fee

Below please find the license fee structure. Invoices will NOT be sent this year. If you would like us to send an invoice for your license fee please contact our accounting office.

2025 Licensing Fees are as follows:

One Division           $1,400
Two Divisions    $1,750
Three Divisions       $2,100

We are offering the following discounts:

Payment of license fee postmarked on or before December 31, 2024 will receive a 10% discount .

Your entire license fee must be postmarked no later than 60 Days prior to your Local Race date in 2025.

All New Local Race Directors and Assistant Directors are required to submit the Local Race Director Resume and References form and a copy of a legal ID.

You must specify any additional insured in the Local Race Request form.

The Licensee agrees to comply with all signage and decal requirements of any national and/or title sponsor of the International Soap Box Derby, Inc.

I certify that all of the information on this Local Race Request form to be true to the best of my knowledge and will accept all conditions herein and will be bound by the 2024-2025 License Agreement.

E-Signature Local Race Director *

First NameLast Name

Local Race Request Form

Local Race Information

Local Race Director Information

Local Race City Organization Information

Licensee & Insurance Information

Additional Insurance