Untitled Page

Online Entry Form

Name:

Address:

City, State, Zip:

Age:

Phone Number:

Sponsors:

Email Address:

Birthdate:

First Class Selection

First Class Brand

First Class Number

Second Class Selection

Second Class Brand

Second Class Number

Third Class Brand

Third Class Number

Third Class Selection

Fourth Class Brand

Fourth Class Number

Fourth Class Selection

Riders Signature:

Parent/GuardianSignature:

Date:

I UNDERSTAND THAT THE LANDOWNERS, PROMOTORS, AND TRACK OFFICIALS, AND THE AMXA ARE IN
NO WAY RESPONSIBLE FOR INJURY TO PERSONS, DAMAGE AND/OR LOSS OF PERSONAL PROPERTY.  I
DO KNOW THAT MOTORCYCLE RACING IS DANGEROUS AND THAT I AM RESPONSIBLE FOR MY OWN 
INSURANCE, AND I FURTHER UNDERSTAND THAT THERE MAY NOT BE AN AMBULANCE ON SITE FOR 
RACING EVENTS AND/OR PRACTICE.  IT IS UNDERSTOOD THAT I MAY BE DISQUALIFIED AND/OR PENALIZED
NOT ONLY FOR MY ACTIONS BUT THAT OF MY PIT CREW AND/OR FAMILY, AND IN SUCH EVENT, NO FEES
WILL BE REFUNDED.  IN THE EVENT THAT THE RACES ARE STOPPED FOR ANY REASON AND THE FIRST
MOTOS HAVE BEEN COMPLETED, THE RACES WILL BE COMSIDERED COMPLETE.  I ALSO UNDERSTAND THAT
I WAIVE MAY RIGHT TO SUE FOR ANY REASON WHATSOEVER THE EVENT PROMOTOR, TRACK OWNER, LAND-
OWNER, OR ANY ONE ELSE AFFILIATED WITH THIS SERIES OR RACING EVENT.

Class Selection