Register Crew Member

This information will let us know more about you.

Crew Information

Emergency Contact

Information is only shared with EMT staff.
  1. By filling this form, I understand that the information used or disclosed may be subject to re-disclosure by the person or class of person or facility receiving it, and would then no longer be protected by federal privacy regulations
  2. I may revoke this authorization by notifying the track/series in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions
SelectName Select all that applyPrice
Line Total$0.00
Processing Fee$0.00

Driver Association

Who will you working with?

Consent to follow the rules.

I agree to all rules and terms of the Jefferson Speedway.
Processing Fee: $0.00
Total: $0.00