SoCal OTMX 2014 INTERNATIONAL EVENT Glen Helen Raceway October 18-19, 2014 Your OTMX Chapter: ___________________________________ OT 5-MOTO MAIL IN ENTRY____ $95 OT 5-MOTO POST ENTRY ____ $105 60-70 Nov, 70 Intermediate, 70 Exp, 75-80 Classes _____ $85 MAIL IN 60-70 Nov, 70 Intermediate, 70 Exp, 75-80 Classes _____ $95 POST Mail in entries for OTMX classes: please include a photocopy of the rider’s 2014 OTMX Membership Card with date of birth and class, or you will need to present your card at check in. All Post Entry must present a 2014 OTMX Membership Card to ride in an OTMX Classes at sign up. Check In and Sign Up opens 4 PM Friday and 6:30 AM Saturday +40 Novice______ +50 Novice _____ +60 Novice ______ +70 Novice ______ Intermediate______ Expert ______ Intermediate ______ Expert ______ Intermediate ______ Expert ______ Intermediate ______ Expert ______ Support Classes: [ ]Novice Master ______ +75 Class______ Master ______ Master ______ +80 Class______ (free entry) Master______ [ ] Intermediate [ ] Expert [ ] +30-39 [ ]Mini [ ] Women (WMN) [ ] +40 Support All Support Classes $35.00; $55 if riding both days! NO SUNDAY ONLY OLD TIMER ENTRIES; ALL SUPPORT CLASS ENTRIES ARE EITHER DAY OR BOTH PLEASE PRINT CLEARLY NAME ____________________________________ ADDRESS ______________________________________ CITY______________________________________________ STATE __________________ ZIP____________ PHONE NUMBER (______) ______________ EMAIL __________________________________AGE _______ RIDING NUMBER ________MOTORCYCLE _________SIZE _____DOB:_____________________________ Emergency contact: ______________________________________ phone number: _______________________ There will be Practice on Friday, October 17th, 8AM to 2PM. ($25 Per Bike) Those riders who do not have the proper color background will be docked a lap for each moto they ride with the wrong color background (per IOTMX rules). Each OTMX Pre-Entries receive an event shirt. All OTMX entries receive one dinner ticket. Additional shirts will be available while supplies last. Extra Dinner Tickets are available at $15.00 EACH. Number of tickets _______(enclose payment) Every OTMX PRE-ENTRY receives an Event T-Shirt, SPECIFY SIZE: [ ] XXXL [ ] XXL [ ] XL [ ] L [ ] M By International Rule, All Questions or Protests must be made with your club representative. UN sportsman like behavior may result in being asked to leave the event. Do not approach or confront scorers. Rain or Shine: This will be a 5-moto event per IOTMX rules; 70+ classes and 60 Novice class will run 4 motos. Support classes – 2 motos Saturday and 2 motos Sunday. Trophies are based on mail entries; 33% trophies awarded. Track gates open at 6:30 a.m.; gate fee is $10.00 per person per day. There is NO CAMPING FEE! Practice begins at 7:30 a.m. SHARP. Mail Entry Deadline: October 15th, 2014 (Wednesday). Make checks payable to: SoCal OTMX, Inc. Additional info may be found at: Mail Entries to: SoCal OTMX, Inc. 25331 Cheyenne Way Lake Forest, CA 92630 socalotmx.org Total Enclosed: $________________ (Turn over to complete page 2!) SoCal OTMX 2014 INTERNATIONAL EVENT Glen Helen Raceway October 18-19, 2014 RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT: I, the undersigned, do hereby for myself, my heirs, executors, and assigns release, remise, and forever discharge and agree to indemnify and hold harmless the Old Timers’ MX Association and its officers, agents and employees, of and from any and every claim, demand, action, or right of action of whatsoever kind of nature and any cost, loss, or expense in connection therewith arising from participation in any events sanctioned by the Old Timers’ MX Association or promoted by the Old Timers’ MX Association, or any related facilities, including any claims or demands for injury to or death of any persons or any damage to or destruction of any property resulting from or claimed to result from or arise out of any accident or occurrence during or in connection with said events, including specifically such as may arise out of or be claimed to arise out of negligence on the part of said Old Timers’ MX Association, its officers, agents, or employees. I further agree that the Old Timers’ MX Association shall not be liable for loss, injury, or damage caused to the rider resulting from: An act, omission, or order of the motorcycle owner or the owner of the motorcycle or equipment or the servant, agent, or employee of either the motorcycle owner of the owner thereof. The nature of the article, or any defects, characteristic, or inherent vices thereof, including susceptibility to, because of atmospheric conditions such as temperature and humidity, or change therein. Earthquake, flood, rising waters, or other act of God. Fire, explosion, lightening, windstorms, tornado, cyclone, hurricane, collapse of building or sprinkler tanks, fall of elevators, leakage or failure of sprinkler systems. Strikes, lockouts, labor disturbances, riots, civil commotion’s, or the act of any person of persons taking part in any such occurrence or disorder. The conditions of the land upon which the race is conducted or the condition of the race course. I FURTHER UNDERSTAND THAT MEMBERSHIP IN THE OLD TIMERS’ MX ASSOCIATION DOES NOT IN ANY WAY INCLUDE OR GUARANTEE ME ANY INSURANCE COVERAGE OF ANY KIND. I have read the foregoing waiver, indemnification, and release and fully understand that no officer or agent or employee of the Old Timers’ MX Association is authorized to vary the terms or provision of this instrument or to make any representations contrary to the provisions hereof. SIGNATURE OF APPLICANT: __________________________________________DATE: _______________ PARENT SIGNATURE (Required for Support riders under the age of 18 years): _________________________ PRINT RIDERS NAME ______________________________________________________________________ RIDER’S SIGNATURE ____________________________________________ AGE _____ DATE ___________ PARENT’S SIGNATURE ____________________________________________________ (If Rider is under 18)