Name:
Birthdate:
Age:
Address:
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I UNDERSTAND THAT THE AMXA ( AMERICAN MOTOCROSS ASSOCIATION, THE LAND OWNERS, PROMOTERS, AND TRACK OFFICIALS OF AMXA ARE IN NO WAY RESPONSIBLE FOR INJURY TO PERSONS, DAMAGE AND/OR LOSE OF PROPERTY. I KNOW THAT MOTORCYCLE RACING IS DANGEROUS. I HEREBY GIVE UP ALL MY RIGHTS TO SUE OR MAKE CLAIM FOR DAMAGES DUE TO NEGLIGENCE OR ANY OTHER REASON WHATSOEVER AGAINST THE LAND OWNER, PROMOTERS, AND TRACK OFFICIALS OF AMXA, EMPLOYEES THEREOF, AND ALL OTHER PERSONS, PARTICIPANTS, OR ORGANIZATIONS CONDUCTING OR CONNECTED WITH THE ASCS, OF INJURY, OR TO PROPERTY AND/OR PERSON I MAY SUFFER, INCLUDING CRIPPLING INJURY OR EVEN DEATH, WHILE PREPARING FOR AND/OR PARTICIPATING FOR OR IN AN ASCS EVENTS AND WHILE ON THE EVENT PREMISES, AND RELYING UPON MY OWN JUDGMENT AND ABILITY, I ASSUME ALL SUCH RISKS OF LOSS AND NEGLIGENCE. I FURTHER UNDERSTAND THAT THE AMXA DOES NOT PROVIDE RIDER MEDICAL INSURANCE. BY SIGNING BELOW CERTIFIES THAT I HAVE READ, UNDERSTAND, AND AGREE WITH THE PROVISIONS OF THIS APPLICATION FOR MEMBERSHIP TO THE AMXA.
Riders Signature:
Parent/Guardian Signature
**Must be signed if Rider is under 18 years old**
Date
Date
Membership Application
2015 American Motocross Association
Membership Fee $25.00
