2025 Membership Form

Membership paperwork and all associated fees MUST be filled out prior to practicing on the track for the 2025 season

Membership Type(Required)

Please select the type of membership you want. Regular membership is $200, Associate membership is $300 (4 race maximum). Each Alternate Handler is $25 additional

Family Membership with Driver(s)Membership

Associate Membership – 4 Race Maximum, NOT ELIGIBLE for year-end awards

Alternate Handler

Product Name

Date(Required)

Primary Handler Name(Required)

Primary Handler DOB(Required)

Primary Handler Phone #(Required)

Primary Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Secondary Handler Name (Usually Spouse)

Secondary Handler DOB

Phone Number

Secondary Handler Address (if different from above)

City

State

Zip Code

Primary Email(Required)

Secondary Email

Driver 1 Name(Required)

Driver 1 DOB(Required)

Age(Required)

Rookie? Yes or No(Required)

Driver 2 Name

Driver 2 DOB

Age

Rookie? Yes or No

Driver 3 Name

Driver 3 DOB

Age

Rookie? Yes or No

Driver 4 Name

Driver 4 DOB

Age

Rookie? Yes or No

How many additional handlers do you need to add to your membership?(Required)

Alternate Handler Name – $25 additional

Alternate Handler Address

Alternate Handler Phone Number

Alternate Handler City/St.Zip

Alternate Handler Name – $25 additional

Alternate Handler Address

Alternate Handler Phone Number

Alternate Handler City/St.Zip

Primary Handler Name(Required)

Secondary Handler Name

Alt. Handler Name

Driver 1 Name(Required)

Driver 2 Name

NCQMA Zero Tolerance Policy

We are very proud of our facility, race track, club officials, members, and our family atmosphere. To ensure that your family’s experience here is a positive one, we have instituted a “Zero Tolerance” Policy. Please review the violations below and make sure that everyone associated with your race team is familiar with them. This Policy will be strictly enforced and all decisions will be made by the NCQMA Board of Directors.

Suspension Terms:

Please acknowledge each term below. By acknowledging, you confirm that you are acting on behalf of all members listed on your NCQMA application.

• NCQMA Board can choose to suspend members, driver, and/or handler at Board's discretion. All Driver Suspensions are for that individual Driver only.(Required)

I acknowledge

• All Suspension Terms begin the following race date on the schedule or as noted above. All Suspensions will be approved by the Board of Directors in attendance of the race event. Suspension Term will be determined by the Board Members in attendance on the date of violation. Suspension will begin at the date of violation. Suspension Term can carry over to next calendar year.(Required)

I acknowledge

• Multiple violations/actions within a 12 month period will receive an extended suspension term.(Required)

I acknowledge

• All Suspension Terms may be adjusted due to the severity of the violation by the Board of Directors. Written Notification of Suspension term will be sent, postmarked within 5 days of violation.(Required)

I acknowledge

• Appeals must be received in writing within 7 days of receiving written suspension notification. Any race missed due to a DQ or suspension in reference to a filed ZTP will not be allowed to be used as a "drop" in either Championship Series or Summer Series final points.(Required)

I acknowledge

• An appeals committee will be set up by the Board of Directors. This committee will consist of 3 NCQMA club members (in good standing with the club), a race day official, and a Board member.(Required)

I acknowledge

• ZTP form must be filed within 24 hours after the incident. Form may be submitted in person or emailed to any Board member. The form can be requested from a Board member or downloaded from the members only page on the NCQMA website.(Required)

I acknowledge

• All information involving ZTP violations will be kept confidential between the Board and the parties involved.(Required)

I acknowledge

Primary Handler Name(Required)

Secondary Handler Name

Alt. Handler Name

Driver 1 Name(Required)

Driver 2 Name

Authorization for Publicity Usage – Family

Please acknowledge the below statements. If you wish to not have your pictures taken or used for promotional material, please reach out to NCQMA track secretary immediately.

I DO NOT wish to have any photos taken or photos to be used in any promotional material.

PLEASE DO NOT USE PHOTOS OF MY CHILD

I hereby grant the North Carolina Quarter Midget Association (“NCQMA”) permission to use photographs, motion pictures/videos, and/or audio recordings containing my name and likeness and/or the name and likeness of my minor child(ren), with or without racing equipment, taken, made, transmitted, reproduced, and/or used during any NCQMA event, including, but not limited to practice, qualifications, the race, and award ceremonies, for publicity and promotional purposes.(Required)

I acknowledge

I understand and agree that these materials will become the property of the NCQMA and will not be returned. I also understand that these materials may or may not be displayed on the website or used in any official publications or displays, at the sole discretion of the elected NCQMA Board or Officials. (Required)

I acknowledge

I hereby irrevocably authorize the NCQMA to edit, alter, copy, exhibit, publish, or distribute the materials for the purposes of publicizing NCQMA’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy. Additionally, I hereby acknowledge and agree that I have no right, property, or interest in any royalties or other compensation arising or related to the use of these materials. (Required)

I acknowledge

I hereby hold harmless and release forever discharge the NCQMA and its members from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. (Required)

I acknowledge

Primary Handler Name(Required)

Secondary Handler Name

Alt. Handler Name

Driver 1 Name(Required)

Driver 2 Name

Social Media Policy

The USAC Social Media Policy can be found at USAC25.com under Rules & Tech.

Primary Handler Name(Required)

Secondary Handler Name

Alt. Handler Name

Driver 1 Name(Required)

Driver 2 Name

NCQMA Work Detail Policy

We are very proud of our facility and the enjoyment that it brings everyone. To maintain its beauty and functionality, we have implemented three different, but related policies: the Work Detail, Demo Day and the Race Day Opening/Closing Policies. Please review the policies provided and the requirements below. Make sure everyone associated with your race team is familiar with them. These policies will be strictly enforced and all decisions by the NCQMA Board of Directors (BOD) are final.

Race day opening/closing duties will be selected by members via an online signup form. Each family must select a minimum of 2 opening or closing spots (2 openings, 2 closings or 1 opening and 1 closing). The number of required spots may change based on the number of active families each year. Members should report to the assigned captain at the start of duties to receive their tasks and after tasks have been completed to sign off. Failure to check in with the assigned captain at the conclusion of opening/closing duties may result in a penalty.

Members who sign up for opening/closing duties MUST participate on the dates they signed up unless they have made prior arrangements to switch with another family.

Primary Handler Name(Required)

Secondary Handler Name

Alt. Handler Name

NCQMA Committee Commitment Form

The NCQMA Board of Directors requires every NCQMA family to commit to active participation in one of the six committees at NCQMA. Full member participation is required to ensure that NCQMA is a successful, fun‐filled club.

Please which committee(s) you would like to be on (at least 1 committee choice per family is required)(Required)

Publicity

Special Events

Trophies & Awards

Fundraising

Sponsorship

Yearbook

Banquet

Host Family (New 2025 families not eligible)

I am interested in leading a committee

NCQMA Member Name(Required)

Email Address(Required)

Payment Type

NCQMA accepts, cash Venmo or check. Any returned checks will result in a $25 fee + any additional bank fees and must be paid within 30 days – or NCQMA membership will be revoked. All membership fees MUST be paid in full by 02/02/2025. If you are paying via Venmo, you will send your payment to @NCQMA-NCQMA in the Venmo app. Please include the primary handler name from your registration and the race date in the memo on your payment.

How will you be be paying your NCQMA 2025 Membership Fee(Required)

All membership dues (and USAC Membership) are required to be made prior to any on track practicing in 2025

Venmo

Check

Cash

2025 Membership Form

2025 Membership Paperwork

Membership paperwork and all associated fees MUST be filled out prior to practicing on the track for the 2025 season

RESERVED PARKING FUNDRAISER

Parking Space Selection

If NEW or request to MOVE/CHANGE spots, please complete the following

NCQMA Zero Tolerance Policy

Suspension Terms:

Authorization for Publicity Usage – Family

Social Media Policy

NCQMA Work Detail Policy

NCQMA Committee Commitment Form

Payment Type