AMA D17

DISTRICT 17 AMA CLUB COUNCIL, INC.

REGISTRATION APPLICATION

Fill out form completely.
AMA Membership must be paid for current year.

(If you wish to utilize the family membership discount it can only be done by mail.)


PLEASE READ CAREFULLY

In consideration of being granted an amateur competition number and in consideration of being permitted to enter competi-tion events, during the current racing year from 1/1/18 to 1/31/19, sanctioned by the American Motorcyclist Association and under the rules of The District 17 AMA Club Council.

I hereby release, and agree to hold harmless the American Motorcyclist Association, the promoters, the owners and lessees of the premises, the participants, and the officers, directors, officials, representatives, agents and employees of all of them, of and from all liability, loss, damage or injury (including death) to my person or property, in any way resulting from, or arising in connection with all District 17 events, and whether arising while engaged in competition or in practice or preparation there for, 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 events, so voluntarily and in reliance, upon my own judgment and ability, and I thereby assume all risk for loss, damage or injury (including death) to myself and my property from any cause whatsoever.

I understand that a District 17 Card for Amateur Events is subject to American Motorcyclist Association Rules for Competion and that of District 17 AMA Club Council.

I hereby make oath and say that to the best of my knowledge and belief all statements set forth in this report are true and correct.

If under 18, Parent signature is required.

ALL FIRST TIME RIDERS UNDER 18 YEARS OF AGE MUST SEND A COPY OF BIRTH CERTIFICATE


REGISTRATION VALID FOR ALL DIST. 17 EVENTS
POINTS WILL BE ISSUED FOR ONLY THE CLASSES YOU INDICATE AND PAY FOR.
REGISTRATION CARD = $20.00 AND $5.00 PER CLASS UNTIL MARCH 1st.
AFTER MARCH 1st = $25.00 AND $5.00 PER CLASS
(MINIMUM 1 CLASS)
PLEASE Check the box for CLASSES IN WHICH YOU WISH TO COMPETE IN FOR POINTS.

**See rule book for more information

Please note the classes below are considered just like a number issued class & are $5.00 per type.

Check Box for Award JACKET SIZE Below.

(Please note number availability is limited, you may not get desired number)

After submitting you will be redirected to PayPal to complete payment.