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*2009 Series Registrstion*
Please Complete the following information (one form per person):
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Date of Birth:
(mm-dd-yyyy)
Phone Number
:
(aaa-bbb-cccc)
Emergency Phone:
(aaa-bbb-cccc)
E-Mail Address:
Confirm E-mail
:
Race Machine:
Honda
Yamaha
Suzuki
Kaw
KTM
Can Am
Polaris
Apex
ARC
ATK
DRR
Other
Race Machine Model:
MOTOR SIZE IN cc
List your top three desired race numbers:
(see
CLASSES
for your number range)
A Program
(Expert/Intermediate)
Expert/PRO
Open A
30+ Intermediate A
OPEN Intermediate A
B Program
(Amateur)
OPEN B
OPEN UTILITY B
Amateur B
JUNIOR B
C Program
(Lady/Age)
Lady Open
OLD PROS (50+)
AMATEUR UTILITY
Youth C
Pee Wee Program
6 Under
8 Under
10 Under
12 Under
Buddy Class
Buddy Race 2 MAN(QUADS)
UTV RACE (side by side) 2 MAN (track permitting)
Competition registration fee is
$20.00
for the first class entered
and
$10.00
for each additional class entered. Membership is
$100
(optional).
Click Submit to proceed.
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