APPLICATION FOR LIFETIME CREDENTIALS

PLEASE RETURN COMPLETED APPLICATION TO:

FEDERATION OF CALIFORNIA RACING ASSOCIATIONS, INC.

P.O. BOX 467

La Verne, California 91750-0467

NAME OF

RETIREE ______________________________________________________________________________

(Please Print) LAST FIRST Middle Initial

SOCIAL SECURITY NUMBER / / DATE OF BIRTH ________________

NAME OF UNION_____________________________________________________________

JOB CLASSIFICATION_________________________________________________________

ARE YOU NOW RECEIVING PENSION BENEFITS FROM A PENSION PROGRAM?

YES___ IF YES, WHEN____/____ Please attach a copy of the pension benefit**

NO____ Last Date Employed _____/_____/_____/

Month Day Year

**Please note Unions will not give pension information over the phone due to security purposes.

You MUST attach proof of benefit or I will not be able to supply the credentials.

YOUR MAILING ADDRESS

______________________________________________________________

Number Street Apt. #

______________________________________________________________

City State Zip Code

YOUR TELEPHONE NO. __(________)_____________________________

Area Code

APPROXIMATE NUMBER OF YEARS EMPLOYED IN RACING INDUSTRY:

(Please list racing associations for which you have worked and approximate number

of years worked for each association)

ASSOCIATION: NO. OF YEARS WORKED

_____________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

YOUR SIGNATURE

______________________________

^{FORMLTP.DOC DATE}

^{7 - May - 2003}