2023 Motorcycle Cannonball Registration Form

2023 Motorcycle Cannonball Registration Form
Section I Personal Information
Name*
Rider #
Preferred mailing address*
City*
State/Country*
Zip Code*
Cell Phone*
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
For Publicity Purposes: Home Town
T Shirt size*
Team Name (optional)
What previous years have you competed in the Motorcycle Cannonball

201020122014201620182021
Emergency Contact*
Phone #*
Relation to you*
SECTION Il DESCRIPTION OF MOTORCYCLE:
Year*
Make*
Model*
Color
Number of Cylinders*
Displacement in CC's*
Transmission How Many Speeds?*
Range (in miles)
Are you planning on running a Sidecar?
Passenger Name
" Please note that a valid and current State Registration and Insurance policy will be required and must be presented at registration"
SECTION III SUPPORT CREW
Support Crew will be added to certain Email and Text Updates Please note that each rider will be issued up to 2 support crew badges with each entry, additional support crew will be charged an additional $100.00 per support crew member)
Support Crew #1

Full Name Cell NumberEmail
Support Crew #2

Full Name Cell NumberEmail
Support Crew #3

Full Name Cell NumberEmail
Support Crew #4

Full Name Cell NumberEmail
SECTION IV OFFICIAL SUPPORT VEHICLE
I will Have a Support Vehicle*

YesNo
I WILL SHARE a SUPPORT Vehicle with (name)
Type of Support Vehicle

Pick Up TruckVanMotorhomeOther
I will have a Support Trailer*

YesNo
Length of Trailer
I will be traveling with a RV or Camper?

YesNo
Size and Length
"Please note that Support vehicles will have to have current state registration and Insurance"
SECTION V HOTELS
Number of rooms required in each overnight city?*

None1 Room2 Rooms3 Rooms4 Rooms
If you are planning on sharing a room with another rider, who do you plan to share a room with? (make sure that only one of you select the room above)
Preferred Room #1

KingDouble Queen
Preferred Room #2

KingDouble Queen
Preferred Room #3

KingDouble Queen
Preferred Room #4

KingDouble Queen
If there are other riders involved with these room selections please speak to them about lodging arrangements and note that here; we want to make surethat rooms are not being doubled counted by other riders. Also if you think you will need any additional rooms in overnight cities for family / guests please annotate that here also. Note: it is not guaranteed that we will be able to accommodate the extra rooms, but this gives us a good idea of what we need to secure.
SECTION VI CONDITIONS OF ENTRY
1.Owner/Entrant understands this entry constitutes an agreement with Motorcycle Cannonball to take part in the 2023 Motorcycle Cannonball's Endurance Run.

2. The undersigned hereby agrees to comply with all federal, state, and local laws related in any way to the event.

3. The undersigned certifies all information on this form is true to the best of his/her knowledge, and that licenses, registrations,andinsurance policies will be legally valid and in force throughout the duration of the event. All licenses, registrations, and insurance policies must be carried by the respective rider(s), and be available for inspection upon request.

4. The undersigned hereby agrees to comply with all Event Regulations as well as any and all Supplemental Regulations, and to inform all Team and Support Crew members of the Regulations. The undersigned agrees that if ANY member of his/her Team or Support Crew violates any Event Regulation, it can result in penalties and/or disqualification for the team. ALL Team and Support Crew members must sign waivers when joining Motorcycle Cannonball.

5. Entrants understand that the initial entry deposit is due no later than 7 days of acceptance and that the remainder of the entry fee for the event will be due between January 1, 2023 and March 1, 2023. Entrants understand that deposits and entry fees are non-refundable and non-transferable for reason.(You may request a refund of the deposit by December 1, 2022. If The Motorcycle Cannonball can fill your spot, a refund any will be issued less fees incurred by Motorcycle Cannonball and $100.00 administrative fee)

6. In consideration of participation in this event, all participants agree to permit Motorcycle Cannonball, the promoter of the event, and their assigns, the use of name(s), voice and/or likenesses, and photographic images of their vehicles for news, publicity, and feature use, films and video, newspapers, magazines, and all other media in connection with advertising and for the purposes of trade.
SECTION VII OTHER REQUIREMENTS
1.  Entrants must provide 2 digital pictures to be placed on the Motorcycle Cannonball website within 30 days of acceptance. These pictures will beunder your rider profile (you can send as many as you like at any time to be added and or updated to your profile, however, we must receive them electronically)

Sent to cannonballwebsite@gmail.com

2.  Entrants must provide a formal rider biography for their website profile within 30 days of acceptance.

Sent to cannonballwebsite@gmail.com

3. Entrants must read, sign, and return a copy of the event regulations once they are issued.

4. Deposit Due within 7 days of acceptance

5. Entrants must provide a short video of themselves and the motorcycle or project by May 15, 2023. (This can come in the form of a YouTube link, emailed file, or cell phone texted file to promoter; again you can send as many as you want to update on your online profile)

Total Entry fee for the 2023 Motorcycle Cannonball Endurance Run: $3,500.00

Deposit Due with Completed Entry within 7 days of acceptance. $1,000.00 to be paid with online link (accepts all major credit cards, PayPal)

If you need other payment arrangements, please contact

Jason Sims at 605-484-8576 or jason@motorcyclecannonball.com

Remaing Entry Fee: Due Between January 1, 2023 and March 1, 2023 $2,500.00 PayPal: to be paid with online link (accepts all major credit cards, PayPal) If you need other payment arrangements, please contact
SECTION VIII NOTES:
if you have any questions or any notes please tell us below
Signature of Entrant

Clear
Date

MonthDayYear
Date
Official Application will not be accepted without signature.
Should be Empty:

2023 Motorcycle Cannonball Registration Form

SECTION III SUPPORT CREW

SECTION IV OFFICIAL SUPPORT VEHICLE

SECTION V HOTELS

SECTION VI CONDITIONS OF ENTRY

SECTION VII OTHER REQUIREMENTS

SECTION VIII NOTES: