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Name:

Address:

City, State, Zip:

Birthdate:

Phone Number:

Sponsors:

Email:

Rider Signature:

Parent Signature:

First Class Selection

Brand one

Bike # one

Second Class Selection

First Class Selection

Third Class Selection

Fourth Class Selection

Bike # two

Bike # three

Bike # four

Brand two

Brand three

Brand four

Age:

Waiver : I UNDERSTAND THAT THE LANDOWNERS, PROMOTERS, 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 CONSIDERED COMPLETE. 
I ALSO UNDERSTAND THAT I WAIVE MAY RIGHT TO SUE FOR ANY REASON WHATSOEVER THE 
EVENT PROMOTER, TRACK OWNER, LANDOWNER, OR ANY ONE ELSE AFFILIATED WITH THIS 
SERIES OR RACING EVENT.