MIDWEST VMX MOTOCROSS ENTRY FORM

 

NAME:

EMERGENCY CONTACT NAME:

 

EMERGENCY CONTACT PHONE NUMBER:

 

SKILL LEVEL (CIRCLE ONE):    EXP       INT          NOV

(Your skill is determined by your AHRMA placement, AMA District, or by Midwest VMX)

CLUB MEMBER #

 

Text Box: READ THIS RELEASE RELEASE: I hereby release and agree to hold harmless Midwest VMX, the AMA, the promoters, the owners and lessees of the premises, the participants, sponsors, and the officers, directors, officials, representatives, agents and employees of all of them of and from all liability, loss, claims and demands that may accrue from any loss, damage or injury (including death, loss of limbs and permanent disablement) to my person or property, in any way resulting from, or arising in connection with this event, and whether arising while engaged in competition or in practice or preparation therefore, or while upon, entering or departing from said premises, from any cause whatsoever. I know the risk and danger to myself and property while upon said premises or while participating or assisting in the event, so voluntarily and in reliance, upon my own judgment and ability, and I thereby assume all risk for loss, damage or injury (including death, loss of limbs and permanent disablement) to myself and my property from any cause whatsoever. I have no known PHYSICAL PROBLEMS that will endanger others or myself while participating in this event. AGREEMENT: By my signature below, I hereby agree to the terms of the above release and further agree to abide by the AMA amateur rulebook, and any other rules addendums. I HAVE READ, UNDERSTAND AND AGREE TO THIS RELEASE:         (Signature)
 FILL IN BIKE NUMBER AND YEAR/MODEL/CC FOR THE CLASSES YOU ARE ENTERING:

PLEASE MAKE SURE YOU ENTER THE PROPER

CLASS – AND CIRCLE YOUR SKILL LEVEL!

Class

Number

Year/Model/CCs

Vintage 125

 

 

Vintage 250

 

 

Vintage 500

 

 

Vintage Novice

 

 

Vintage Open Age

 

 

Vintage 40+

 

 

Vintage 50+

 

 

Evolution 125

 

 

Evolution 250

 

 

Evolution 500

 

 

Evolution Novice

 

 

Revolution Light

 

 

Revolution Heavy

 

 

Revolution Novice

 

 

Evo/Revo Open Age

 

 

Evo/Revolution 40+

 

 

Evo/Revolution 50+

 

Schoolboy Twin Shk

 

 

Schoolboy Mono Shk

 

 

Innovation Light

 

 

Innovation Heavy

 

 

Innovation Novice

 

 

Innovation Open Age

 

 

Women

 

 

Modern Light

 

 

Modern Heavy

 

 

Modern Novice

 

 

Modern 35+

 

 

 

 

 

65cc

 

 

85cc

 

 

Youth Lites

 

 

 

 

 

Youth I Exhibition

 

 

Youth II Exhibition