Gran Prix Racing Sponsored By

Gran Prix Racing Sponsored By: SWAMP CREEK MC & Sanctioned BY OMRA Rider Information

If you want us to get the info correct- Write so we can read it!!!

Rider Name: Address: City:

Age:

Phone: State: Zip:

MAKE OF BIKE

KAW

Class

A-EXP

AA

AA

KTM

BINT

CBEG

OPEN

X

A

K

(any CC) 200,

Z

E

B

250 4- Stk 30

U

D

T

40

V

F

C

50

R

Y

2 Stk,

60

Q

70

P

Women

W

SUZ

HON

CC:

YAM

OTHER

Sportsman Junior

S JA

JB

JC

PLEASE CIRCLE YOUR CLASS

Release: I, hereby release, and agree to hold harmless Swamp Creek MC, OMRA, the Promoters, the land owners, the land lessees, the participants, sponsors, the officers, directors, officials, representatives, agents and employees of all of them, of and from all liability, loss, claims and demands that may occur from any loss, damage or injury (including death, loss of limbs and permanent disablement) to my person or property, in any way resulting from, or arising in connection with this event and whether arising while engaged in competition or in a practice or preparation therefore, or while upon, entering or departing from said premises from any causes whatsoever. I know the risk and danger to myself and property while upon said premises or while participating or assisting in this event, so voluntarily and in reliance, upon my own judgment and ability and I thereby assume all risk for loss, damage or injury (including death, loss of limbs and permanent disablement) to myself and my property from any cause whatsoever. Agreement: By my signature below, I hereby agree to the terms of the above release and further agree to abide by the OMRA rule book and any special regulations of Swamp Creek MC during this event.

Rider Signature Date