Registration

Team Name *

Class and Fee Schedule *

Payment Type *

Preferred Race Number: Please choose 3 different numbers between 20 and 200. list in order of preference. If all your choices are taken, these numbers will be assigned to you *

Preferred Race Number (2nd Choice) *

Preferred Race Number (3rd Choice) *

Racer #1 First and Last Name *

Racer #1 Email *

Racer #1 ATVA/AMA Membership # *

Racer #1 Machine Brand *

Racer #1 Date of Birth *

Racer #1 Hometown and State *

Racer #2 Fist and Last Name *

Racer #2 Email *

Raver #2 ATVA/AMA Membership # *

Racer #2 Machine Brand *

Racer #2 Date of Birth *

Racer #2 Hometown and State *

Racer #3 First and Last Name *

Racer #3 Email *

Racer #3 ATVA/AMA Membership *

Racer #3 Machine Brand *

Racer #3 Date of Birth *

Racer 3# Hometown and State *

Please Sign *

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