IN CONSIDERATION OF the permission granted to me to participate in the event as owner or driver of a competing vehicle, member of a crew, official, photographer, reporter or in any manner whatever:

I the undersigned, being of lawful age, for myself, my heirs, executors and assigns, represent to and agree

with the above named sponsor, the below named real estate interest involved, all officers of such sponsors, participating members, drivers, owners, crews, officials, and all persons who execute a Liability Release, and the heirs, executors, assigns and successors of all of them (all such persons, firms and corporations are hereinafter collectively called "Beneficiaries of this agreement"), as follows:

(1) I AM WELL AWARE of the ordinary and extraordinary hazards of automotive competition and exhibition and risks of negligence, gross negligence, and intentional and unintentional violation of competition and other rules and regulations in the selection, layout and maintenance of premises, in the conduct of events, and in the inspection, condition and operation of vehicles on or near premises before, during and after events. I assume all such hazards and risks in connection with this event.

(2) WITH RESPECT TO MY BODILY INJURY OR DEATH< LOSS OR DAMAGE TO PROPERTY owned by me or in my possession or under my control, and any and all expenses to me, resulting directly or indirectly from any occurrence at or near premises used in the Event and nearby premises, or at any place unutilized in connection with the preparation for or conduct of the Event below designated, caused or contributed to in any way by the actions or failures to act of Beneficiaries of the Agreement, including, his, her or their NEGLIGENCE, GROSS NEGLIGENCE or BREACH OF STATUTORY OR OTHER DUTY OR ANY KIND:

(a) I HEREBY ASSUME ALL RISKS THEREOF,

(b) I HEREBY RELEASE< WAIVE AND DISCHARGE any and all claims, demands and causes of action, past, present and future, I may have against BENEFICIARIES of this Agreement with respect thereto.

(c) I HEREBY AGREE that the provisions of this agreement are severable and that each of them is inoperative if it is not enforceable against me but that the non-enforceability of any of these provisions shall not vitiate provisions of this agreement.

(3) 1 HAVE READ AND I UNDERSTAND THIS CONTRACT. It contains the entire understanding between the Beneficiaries of this Agreement and me. It may not be modified orally.

SIGNATURE                                                                                                                                                DATE                                                         

EVENT LOCATION                                                                                                                                   
                                                                                                                                                                                                                                                                                                        

Pres. Kruck.'94

Page 2

                                                  VEHICLE INFORMATION

Year                                                            Displacement                                                                                                                                           Type of Event                                       
 

License No.                                               State                                                                                                                                                          Date                                                        

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - -- - - - - - - - - - - - - - - - -
(Do Not Write Below - Official Use Only)                                                                                                Driver's Name:                                                                                                      

                                                      TECH INSPECTION                                                                            Address:                                                                                                                

Brake Test                                                    Wheel Bearings                                                                    Operator's License No.                                                                                         

Headlights                                                    Exhaust System                                                                   Navigator's Name:                                                                                                  

Brake Lights                                                 Seatbelts                                                                              Address:                                                                                                                  

Tail Lights                                                    Wipers                                                                                 Club Affiliation:                                                                                                       

Park Lights                                                    Tires                                                                                     Classification:

Turn Signals                                                 Body                                                                                    - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - -- - - - - - - -

Horn                                                              Helmet                                                                                 (Do Not Write Below - Official Use Only)

                                                                                                                                                                                                                                     Entry Fee paid      $                       

REMARKS                                                                                                                                                                                                                Championship fee $                       

                                                                                                                                                                     (Rallye put on by                                                             )

                              Inspector                                                                    

                              Date