Sponsorship Request Form

Name of Individual Seeking Sponsorship*

First NameLast Name

Date of Birth*

Date

Primary Contact (if individual named above is under 18 years of age)*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Which industry is your family associated with?*

HealthcareFire Department & EMTPolice

Which family member is a first responder and/or healthcare frontline worker?*

If other, please specify who:*

How has being part of (or a child of) the first responder and/or frontline healthcare community impacted your life? *

How is being involved in the powersport community beneficial to you? *

How would receiving this sponsorship from the Throttle Relief Foundation help you achieve your goals? *

Upload a picture/video(s) that showcases the rider in acton who is seeking sponsorship (minimum width of 1080 pixels). This will be used on social media to introduce and congratulate the rider. *

Which event(s) are you looking to be sponsored for?*

December 5-8, 2024: AZ Open Motocross Championship (Buckeye, AZ)March 1-3, 2025: AZ State Championship (Buckeye, AZ)

How did you hear about this sponsorship opportunity? *

Media Consent and Release

By signing below, I hereby authorize Throttle Relief Foundation and its partners, agents, representatives, assigns, successors in interest and licensees, to photograph, audiotape, and/or videotape me and grant the Organization and its partners the right to use my photograph, audio recording, video recording, or any reproduction or modification thereof (the “Photograph,” “Audio,” and/or “Video”), in any manner or medium throughout the world an unlimited number of times in perpetuity in advertising, trade, promotion, exhibition, or any other lawful purpose.

I understand that I will not receive any monetary compensation for the permissions I am granting herein. I hereby waive any right of inspection of approval of the uses to which the Organization may put the Photograph, Audio, and/or Video. I acknowledge the Organization will rely on this permission and hereby release and discharge the Organization from any and all claims and demands arising out of or in
connection with the Photograph or the exercise of the permissions granted here, including any or all claims for libel, invasion of privacy, or emotional distress.

I understand that I cannot withdraw my consent after I sign this form and that this consent and release is binding on me and my heirs, legal representatives and assigns.

I grant permission for Photographs to be collected and used by the Organization.*

YesNo

I grant permission for Audio to be collected and used by the Organization.*

YesNo

I grant permission for Video to be collected and used by the Organization.*

YesNo

Signature*

If the individual named above is under 18 years of age, please complete the following:
I am the parent or legal guardian of the individual named above, and I hereby sign this Media Consent and Release on behalf of such individual in accordance with the statements above.

Parent or Legal Guardian Signature (if needed)