2026 URA License Application

Florence Motor SpeedwaySouthern National Motorsports Park
License Information
Licensee Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Licensee*
Mother, Father, Spouse, etc.
Releases & Agreements
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.
Licensee Signature for Releases & Agreements*

Clear
Date Signed*

MonthDayYear
Date

License Type*

LMSC Driver License

$150.00

Driver License

All Other Divisions

$100.00

Crew Member

All Crew Members

$75.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

License Information