(J&S Matus Motor Sports, Inc) 9006 Sundown Drive, Pearland, Texas 77584 Fax: 281-605-1340
Call with questions: 281-303-1844 or 281-802-9863 e-mail: info@texasmile.net ALL FORMS FOUND @ www.texasmile.com
Event Date: October 21-23, 2011
Driver/Rider Name_____________________________________ Home Phone________________________________
Work/Cell Phone________________________ Address______________________________________________________________
City__________________________________ State____________ Zip_______________ DL#___________________ St.____
E-mail___________________________________________________FAX______________ DOB____________ AGE_________
CIRCLE DIVISION TYPE:
Automobile OR Motorcycle
LSR Automobile OR LSR Motorcycle
Exhibition Automobile OR Exhibition Motorcycle
Automobile: Circle one to two CLASS TYPES per vehicle (Extra fee applies to choosing two CLASS types)
1. STREET LEGAL
2. NOT STREET LEGAL
If you chose Automobile, LSR Automobile or Exhibition Automobile Circle or fill in the blanks:
Body Style: Coupe , Hatchback, Sedan, SUV, Truck, Wagon, Convertible
Speed Range: UNDER 190 mph or OVER 190 MPH
Year:_______________
Make:______________
Model:_____________
Predominant Color:______________
Engine Induction: Naturally Aspirated, Single Turbo, Twin Turbo, More Than Twin Turbo, Supercharger,
Supercharger-turbo Combo
Engine Number of Cylinders: 3 cylinders, 4 cylinders, 5 cylinders, 6 cylinders, 8 cylinders, 10 cylinders,
12 cylinders, Rotary, Electric, Hybrid
Engine Cubic Inch/ Liter Equiv. Range:
501.00 cid and over / 8.210 liters and over
440.00 to 500.99 cid / 7.210 to 8.209 L
373.00 to 439.99 cid / 6.112 to 7.209 L
306.00 to 372.99 cid / 5.015 to 6.111 L
261.00 to 305.99 cid / 4.277 to 5.014 L
184.00 to 260.99 cid / 3.015 to 4.276 L
123.00 to 183.99cid / 2.016 to 3.014 L
93.00 to 122.99 cid / 1.524 to 2.015 L
62.00 to 92.99 cid / 1.016 to 1.523 L
46.00 to 61.99 cid / 0.754 to 1.015 L
31.00 to 45.99 cid / 0.508 to 0.753 L
Up to 30.99 cid / 0.507 L and Under
Will Find Out
Fuel: Gasoline, Alcohol, Diesel, Electric, Hybrid Electric, E85
Nitrous: Yes or No
Methanol Injected: Yes or No
Driveline: Rear Wheel Drive, Front Wheel Drive, All Wheel Drive
MOTORCYCLES: Choose one to two CLASS TYPES per motorcycle .(Extra Fee applies to
choosing two types)
1. Inline Motor / Factory Stock
2. Inline Motor / Modified
3. Inline Motor / Unlimited
4. V Twin Motor / Factory Stock
5. V Twin Motor / Modified
6. V Twin Motor / Unlimited
Motorcycle, LSR Motorcycle, Exhibition Motorcycle Circle or fill in the blanks:
Body Style: Sport Bike, Classic/Cruiser/Touring, Sport Touring, Chopper/Bobber, Enduro, Other
Manufacture Origin: USA (American Iron) , Asia, Europe
Year:_______________
Make:______________
Model:_____________
Predominant Color:______________
Engine Induction: Naturally Aspirated, Single Turbo, Twin Turbo, More Than Twin Turbo, Supercharger,
Supercharger-turbo Combo
Engine Number of Cylinders: 1 cylinders, 2 cylinders, 3 cylinders, 4 cylinders, 6 cylinders, 8 cylinders, Electric
Cubic Centimeters:
499cc or less
450cc to 599cc
600cc to 749cc
750cc to 999cc
1000cc to 1199cc
1200cc to 1349cc
1350cc to 1500cc
1501cc +
Fuel: Gasoline, Alcohol, Diesel, Electric, Hybrid Electric, E85
Nitrous: Yes or No
Methanol Injected: Yes or No
Inches over Stock Length:
None
.1 to 2
2.01 to 4
4.01 to 6
6.01 to 8
8.01 to 12
12.01 +
LSR Automobile or LSR Motorcycle:
Please Fill in your Class: ____________________________________________________________________________________
Car/Motorcycle Number – (up to 4 digits): 1st choice _________ 2nd choice_________ 3rd choice__________________
Please check that you have attached or are brining with you all the required forms:
1. Tech Form________ 2. Medical Stats________
IMPORTANT QUESTIONS:
2. Will you be staying in a self-contained motor home (meaning bring own water, generator, etc.). YES or NO
NO DUMPING OF ANY TYPE OF WASTE – fluids or solids. No Outdoor CAMPING ALLOWED (tent, etc.)
Form of payment: Money Order_____Check_____ Cash_____
UNLIMITED RUNS OVER TWO OR THREE DAYS
VISA____MC____ Discover_______
Fri-Sun Entry
Sat-Sun Entry
$360.00 = _______
$260.00 = _______
Card #____________________________________________
Expiration date:_______________
EXTRAS
2nd CLASS TYPE
$65.00 = _______
MOTOR HOME- Overnight Fee $30.00 per night = _______
Second Driver/Rider: goes under your name & number
1 run $40, 2 runs $60, 3 runs $80, 4 runs $100
= _______
Is name & address on entry same as name/address for credit card?
YES____________ If no, insert name and billing address below:
___________________________________________________
___________________________________________________
(RIDER refers to motorcycle rider NOT passenger)
TOTAL AMOUNT $__________
I hereby authorize NASA Texas/The Texas Mile to charge my credit
card listed for the total fees listed in this entry.
I have read, understand & agree to all the stipulations outlined
in the NASA TEXAS/Texas Mile Entrant Agreement and
Release: Signature:_________________________________
Signature__________________________________
Date:____________
(J&S Matus MotorSports, Inc) 9006 Sundown Drive, Pearland, Texas 77584 Fax: 281-605-1340
Call with questions: 281-303-1844 or 281-802-9863 e-mail: info@texasmile.net ALL FORMS FOUND @ www.texasmile.net
page 3 of 3
ENTRANT AGREEMENT and RELEASE
General Stipulations: I am attending this event as a participant, spectator or worker for fun and recreation. I agree to follow the directions of the
Texas Mile Officials. I understand that I may be excused from participation without refund and asked to leave the facility if the Texas Mile Officials
deem my driving unsafe or if my behavior or that of anyone with me is deemed detrimental to the event. I agree that I willingly accept the risk of
driving on the race-track and/or facility, knowing that it may be dangerous. I understand that I am responsible and accept the liability for the safety of
any passengers that I take out on the track in my car during the event. I understand that there is a possibility that I and/or my guest/crew could be
injured or killed at an event. I hereby release the Texas Mile, the National Auto Sport Association, J&S Matus Motorsports, Inc, its officials, officers,
members, workers, sponsors and other participants from any and all liability for damage to my car or equipment, theft of the same, injury or death of
myself and anyone accompanying me at the event and anyone riding with me, whether adult or minor, which may result from my participation in this
event. I agree that I will clean up my paddock area during and at the end of each day before leaving the facility. I will not damage the pavement or
leave fluids such as oil, fuel or coolant on the pavement. I will take them with me. I understand that if I damage the facility in any way, including an
on track incident, that I will be held liable to pay for that damage.
I understand that my entry fee is not refundable. I understand that the event will be run rain, shine or snow and that I will not be refunded due to
weather. Prices are subject to change without prior notice. I understand that the use of any illegal drugs by myself or the people with me will
subject us to immediate dismissal from the event and facility.
I understand that I am the only person responsible for the safety of my vehicle/motorcycle. I understand and agree that I will ensure that all required
safety components are properly installed or fit properly on my motorcycle or in my car and on my person. I understand that the items listed on the tech
sheets does not guarantee my safety and well being nor does it guarantee the safety or well being of others. I recognize and assume all risk of damage,
injury and death that may be caused by a failure of any component of the car/motorcycle, including without limitation the items listed on the tech
sheets and the rules. I have not relied on the list to be comprehensive or tailored to my car or motorcycle; it is instead a guideline. I am responsible
for ensuring that my vehicle/motorcycle is in safe operating condition before each and every event in which I am a participant. I release J&S Matus
Motorsports, Inc DBA The Texas Mile, its sponsors, shareholders, affiliates and all persons that have or might assist in the process of inspecting my
car (collectively, “Released Persons”) from all liability of any kind for any property damage, personal injury or death that may occur to me or any
occupant of my vehicle as a result of any of their acts or omissions, expressly including any negligent acts or omissions by the Released Persons. I
understand that all forms of motor sports are dangerous and can kill me. I am an adult and accept all of these risks and agree not to join the litigious
ranks of persons who believe all injury must be the result of fault by a person with money.
MEDICAL Legal Acknowledgement and Release
I certify that I have been examined by a physician and am physically fit to participate in a high stress, physically demanding driving event and/or
race. I am not pregnant, suffering from any diseases or disorders or under any drugs, legal or illegal, that would affect my performance during this
event. This is to certify that these statements are true and accurate. I agree that it is my sole responsibility to notify official personnel if any
changes have occurred in my medical status and provide The Texas Mile with updated information. I also give permission to any hospital,
institution, or physician, to furnish any information to The Texas Mile Contracted Emergency Response Personnel. I also give the right to medical
personnel
to
treat
me
for
medical
conditions
that
might
occur
while
attending
a
Texas
Mile
Event.
This release is in addition to and cumulative of all releases I have given in conjunction with my entry and participation in a Texas Mile event.
I
have
read,
understand
and
agree
to
all
the
stipulations
outlined
in
the
PRINT NAME:_________________________________________________________________________
Signature of Driver/Rider:________________________________________________________
Date Signed:_______________
The TEXAS MILE
www.texasmile.net
J&S Matus Motorsports, Inc.
Entrant
Agreement
and
Release.