AHRMA NW VMX Pre-Entry

Please consider a Monitory Gift to the AHRMA Benevolent Fund this directly helps injured Riders with medical expenses

Select Event Name/Date*

Member Name

Address

Street Address

Unit or Apt #

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Year of Birth

Emergency Contact Name

Phone Number

Please enter a valid phone number.

Check here if the Emergency Contact is traveling with you

Yes

Name of Emergency Contact At this Event (This person should be able to help you pack or transport your belongings).

First NameLast Name

All AHRMA Membership fees are payable online in advance at Motorsport-Reg or to the Representative at Sign-Ups

Weekend AHRMA Membership $35Annual AHRMA Membership $75 Due at this EventActive MembershipLifetime Member (70+)

Member #

Exp. Date

Date

Race Fees: First Class, $45 Each additional class $30 PAY IN PERSON at the Pre-Entry Registration Line.

Refer to the current AHRMA Handbook Section 18 for questions regarding classes and eligibility.

Classes

	Bike #	Bike Year	Brand Chassis	cc Size	Skill Exp/Int
Premier Lightweight
Premier 350
Premier 500
Premier Open Twins
Classic 125
Classic 250
Classic 500
ESS 250
ESS 500
100cc Motocross
Sportsman 125
Sportsman 250
Sportsman 500
Sportsman Open Twins
Vintage Open Age
Vintage 40
Vintage 50
Vintage 60
Vintage 70
Women

Novice Class

	Bike #	Bike Year	Brand Chassis	cc Size
Premier
Classic
Sportsman
Open Age
40+
60+
Women

RELEASE: I hereby release and agree to hold harmless AHRMA, the promoters, the owners and lessees of the premises, the participants, sponsors, and the officers, di- rectors, 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 a current Medical Insurance Policy and no known Medical Conditions that would endanger myslef or others whiel participating in this event.

My helmet meets all standards as specified in the current AHRMA Handbook.

AGREEMENT: By my signature below, I hereby agree to the terms of the above release, guarantee credit card payment, and further agree to abide by the AHRMA Handbook and any special regulations during the event.

Signature