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C.A.R.T. Online Membership Application

To become a member, you must submit an application either online and pay online thru PayPal (see buttons below), or print the application, and mail it in with payment included. When mailing in payments we only accept checks, cash or moneyorders. To receive an application, please fill out our contact form. Read Notice when paying online and applying online: If you wish to apply and pay online there is an additional small fee becuase of how paypal works. Family Members would be $40.00 plus $1.46 PayPal fee = $41.46 total on your credit card or debit car. Single Members would be $30.00 plus $1.17 PayPal fee = $31.17 total on your credit card or debit car. Be sure you click on the correct button below for payments. Family or Single Membership.

Please fill in all that apply :

Name (First and Last):
Other Family Members (First names):
Address:
City:
State:
Zip:
Age:
Occupation:
Home Phone:
Work Phone:
E-mail:
Fax:
Emergency Contact Name:
Emergency Contact Phone:

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Cars currently owned:

Car 1:	Make:		Model:		Body Type:		Year:
Car 2:	Make:		Model:		Body Type:		Year:
Car 3:	Make:		Model:		Body Type:		Year:
Car 4:	Make:		Model:		Body Type:		Year:

Other Club Affiliation:

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Membership Type:

Please select one option below:

Voting: (Requires 1. Attendance at a minimum of one membership meeting within each 6-month period AND 2. Participation in at least two club events.)

Non-Voting:

Please select one option below:

Single Membership: $30.00 new members and renewal ($31.17 if paying online)

Family Membership: $40.00 new members and renewal ($41.46 if paying online)

List Family members here (Use comma for space):

C.A.R.T. Sponsor (New members need to be sponsored by a C.A.R.T. voting member):

Member Activities: Each member is expected to actively contribute to C.A.R.T. activities, operations and events. Please describe how you plan to support the club. If you are not sure, contact a club officer for assistance prior to submitting your application.

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Release and Indemnification Agreement - You MUST read this before signing!

Release and Indemnification Agreement – You MUST read this before signing! The undersigned acknowledges and understands that the Connecticut Autocross and Rally Team, Inc. (a.k.a. C.A.R.T.) a non-profit Connecticut corporation, will/or may not hold various events and activities, including but not limited to, autocrosses, time trial rallies, or other automotive related events, and/or meetings or other events in which the undersigned may voluntarily and of his/her own volition elect to participate, collectively, to “the Events”. The undersigned acknowledges and understands that the Events in which the undersigned will engage, may involve a risk to injury to the person and/or property of the undersigned and others. The undersigned also acknowledges and understands that there may be unknown and/or unanticipated risks and/or injuries, and in executing this document, the undersigned agrees that this release and indemnification agreement is intended to include and contemplate these risks, injuries and damage to the property of the undersigned and/or others. Now in consideration for the Connecticut Autocross and Rally Team, Inc., allowing the undersigned to participate in the sponsored Event by C.A.R.T., the undersigned agrees to save, hold harmless and indemnify the said Connecticut Autocross and Rally Team, Inc., it’s officers and board members, of and from any and all claims, liabilities and expenses, including attorneys fees, arising because of or out of any claim which hereafter may be presented by anyone for loss and/or damage of any kind, including but not limited to personal injuries or property damage, as a result of or in conjunction with in any matter, the acts, omissions or indiscretions of the undersigned at or related to the events or involving the Connecticut Autocross and Rally Team, Inc., in any way. The undersigned acknowledges and agrees that this Release and Indemnification Agreement shall apply to any and all agents, successors, executors, administrators, and/or assigns of the party (or parties) whom the undersigned agrees to and has or will notify, agents, successor, executing administrators and/or assigns, of this Release and Indemnification Agreement, and the terms of which have voluntarily, and of the party (or parties) own volition been agreed to and accepted prior to participation in the events. The undersigned declares and represents that no promise or agreement has been made, and that this document contains the entire agreement between parties. The undersigned has read the foregoing release and Indemnification Agreement and fully understands it. (Applies to all family members when applying for family membership) The undersigned has read the foregoing release and Indemnification Agreement and fully understands it. (Applies to all family members when applying for family membership.)

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Signed this: of: , 2006-2007

Signed: By typing your name here you are signing.

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FOR RENEWING MEMBERS ONLY!

CAR 1: My car number for 2007 was Driver Name: Car: I would like as my car number for 2008 (if it is available) and I understand other members are allowed to keep their existing numbers unless they give them up or are late on renewal.

CAR 2: My car number for 2007 was Driver Name: Car: I would like as my car number for 2008 (if it is available) and I understand other members are allowed to keep their existing numbers unless they give them up or are late on renewal.

CAR 3: My car number for 2007 was Driver Name: Car: I would like as my car number for 2008 (if it is available) and I understand other members are allowed to keep their existing numbers unless they give them up or are late on renewal.

CAR 4: My car number for 2007 was Driver Name: Car: I would like as my car number for 2008 (if it is available) and I understand other members are allowed to keep their existing numbers unless they give them up or are late on renewal.

After signing hit the back button to select a payment method.

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Payment Options