DELTA MIATA CLUB

1664 Century Oaks Drive

Brentwood, California  94513

                                                                                                                 Date:____________________________

INSTRUCTIONS:

This form limits Delta Miata Club’s liability. Read it thoroughly and sign below.

WAIVER AND RELEASE OF LIABILITY:

The signatory below agree, as a condition of my participation and in consideration thereof, to be solely responsible for any damage or injury to third parties, or to myself resulting from anything connected with this Event and/or Meeting (hereinafter defined). I agree to fully indemnify and hold Delta Miata Club, its officers and representatives harmless for or in any claim, loss, damage, injury or liability which may be asserted against them by me or by any third party as a result of my activity. The foregoing covenants of exculpation and indemnity are intended to be and are complete, general and without restriction and include but are not limited to negligence (active or passive) or willful, reckless or wanton activity. I further agree that the car will be operated by a licensed driver, and that the driver will comply with all applicable provisions of the California Vehicle Code. I further warrant that I carry automobile liability insurance on the vehicle, meeting or exceeding all California statutory requirements to be used in this Event and/or Meeting and that this insurance will be in full force and effect on the date of this Event and/or Meeting. I will not participate in this Event and/or Meeting under the influence of any alcoholic beverages or other drug or drugs which would impair my ability to perform at this Event and/or Meeting.

SIGNATURE/CAR LICENSE#