2024 Race Round 5 Registration Form

2024 Race Registration

and Friday Trackday Form

Which Event*

Do you have a 2024 Membership. If No, you need to complete the 2024 Membership and payment form*

YesNo

Rider Name and Contact Information

First Name*

Last Name*

E-mail*

Phone Number*

Emergency Contact Person

Contact Name*

Contact Phone*

Contact Relation*

Are they here with you for this event*

YesNo

Health Card Number (optional)

Are there any existing medical conditions that you would like MRTS to be aware of? (optional)

Bike Team Details

Bike Number*

Bike Manufacturer

Bike Model

Team Name (if applicable)

Sponsors

Event Purchases(All Prices include Tax)

Friday Trackday ($160 with Season Membership) ($220 without season membership)*

YesNoYes - without season membership

First Race ($170)*

YesNo

First Race Class*

Second Race ($75)*

YesNo

Second Race Class*

Third Race ($45)*

YesNo

Third Race Class*

Fourth Race ($35)*

YesNo

Fourth Race Class*

Fifth Race ($35)*

YesNo

Fifth Race Class*

Sixth Race ($35)

YesNo

Sixth Race Class*

Have you purchased / rented a 2024 AMB My Laps Transponder? If No, you will need to complete the 2024 Transponder Rental form.*

YesNo

Total

Pay via PayPal / Credit Card

CADTotal

This section is completed at the track: Signature (Parent or guardian if under 18):

___________________ _____________________ _______________________

REGISTRAR TECH TIMING