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Name:

Address:

City, State, Zip:

Age:

Birthdate:

Phone Number:

Sponsors:

Email Address:

First Class Selection

Second Class Selection

Brand one

Third Class Selection

Fourth Class Selection

Brand two

Brand three

Brand four

Riders Signature:

Parent/GuardianSignature:

Please come to signup to pay entry fees and sign form

Bike # two

Bike # one

Bike # three

Bike # four

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.