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Pioneer Motorcycle Club

Hillclimb

Entry Form
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Aug. 12, 2017 (Saturday) NO PIT RACING  

RIDERS MEETING on the line 15 minutes prior to start time MAKE CHECKS PAYABLE TO: Pioneer Motorcycle Club

Name
Age/Birthdate
Address
AMA#/Exp. Date
District 11 Yes No
City, State
Phone Number
Zip Code
Email



CLASS MAKE CC RIDING# __________________ $20.00
CLASS MAKE CC RIDING# __________________ $15.00
CLASS MAKE CC RIDING# __________________ $10.00
CLASS MAKE CC RIDING# __________________ $10.00

THIS IS A RELEASE AND INDEMNITY QUAD CLASSES:___________________________
AGREEMENT READ IT BEFORE SIGINING __________450 2 Stroke # (000-039)
__________450 4 Stroke # (040-079)
__________Open 2 Stroke # (080-119)
I hereby give up all rights to sue or make claim for damage due to negligence or any other reason whatsoever against the Pioneer Motorcycle Club, members, officers, American Motorcycle Association and their respective district organizations, the promoters, sponsors, and all other persons, participants or organizations conducting or connected with this event for injury to property or person I may suffer, including crippling injury or death, while participating in the event and while upon the premises. I know the risks of danger to myself and my property while preparing for and participating in the event and while on the event premises and, relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all cost to those persons or organizations connected with this event for damages incurred as a result of my negligence. __________Open 4 Stroke # (120-159)
__________Vet 40+ # (160-199)
YOUTH CLASSES:__________________________
__________50CC (4-8) # (200-239)
__________50CC (6-11) # (240-279)
__________85 & 125CC 4stk (6-12) Girls # (280-299)
__________85CC Junior (7-11) # (300-349)
__________85CC Senior (12-15) # (350-399)
BIKE CLASSES:__________________________
__________125CC # (400-449)
__________250CC # (450-499)
__________450CC # (500-549)
__________600CC # (550-599)
__________Open # (600-649)
THIS IS A RELEASE:_________________________________________ __________Senior 40+ # (650-699)
SIGNATURE OF PARTICIPANT __________86 - 400cc Stock Wheel Base # (700-749)
__________401cc - Up Stock Wheel Base # (750-799)
THIS IS A RELEASE:_________________________________________ __________126-200 2 Stk $ 250cc 4 Stk # (800-849)
SIGNATURE OF PARENT __________Woman's 86cc $ UP # (850-899)
(REQUIRED OF ALL PARTICIPANTS UNDER 18 YEARS OF AGE) __________Super Senior 50+ # (900-949)

DATE:___________________________________________________ __________________________________________________________________

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