Membership Form

Membership Form

RELEASE AND INDEMNITY AGREEMENT:

1, for myself, heirs and assigns, hereby give up all my rights to sue or make any claim whatsoever against the AMERICAN MINI-CROSS ENTERPRISES, their agents and employees, the promoters sponsors, manufacturers and suppliers of equipment and all other persons, participants or organizations conducting or connected with AMERICAN MINI-CROSS ENTERPRISES sanctioned events for any injury to person or property I may suffer (including crippling injury or death), whether such injury arises while I am preparing for competition, taking any proficiency or licensing test, participating in an event, or while I am upon event premises. I know the risks of danger to myself and my property while participating in racing events and while upon event premises, and relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all costs to those persons or organizations connected with sanctioned events for damages incurred as a result of my negligence. DRUG TESTING: I agree to submit to drug and alcohol tests as conducted from time to time by AMERICAN MINI-CROSS ENTERPRISES. In so doing, I recognize that submitting to such test is essential to the integrity and safety of motorcycling sports, I agree that any refusal on my part to submit to such tests will result in cancellation of my membership and license and the loss of all rights to compete in AMERICAN MINI-CROSS ENTERPRISES sanctioned events. PRODUCTION AND PROMOTION RIGHTS: I agree that AMERICAN MINI-CROSS ENTERPRISES, or its assigns, on a nonexclusive basis, may use my name and pictures (including pictures of my racing equipment and pictures taken at any sanctioned event) for any purpose in any media including, but not limited to, television, motion pictures and home video productions. INDEPENDENT CONTRACTOR: I hereby certify that I am not an agent or employee of the AMERICAN MINI-CROSS ENTERPRISES, and I assume all responsibility for all charges, premiums and taxes, if any, payable on any funds that I receive as a result of my competitive activities, including without limitation social security taxes, unemployment insurance taxes, compensation insurance, income taxes and withholding taxes. ACKNOWLEDGEMENTS: I acknowledge and understand that it is my responsibility to properly maintain this membership and license. I understand that competition license and membership is subject to AMERICAN MINI-CROSS ENTERPRISES rules of competition. I am not under fine, suspension, medical disability or any other circumstance which would prevent my participation in AMERICAN MINI-CROSS ENTERPRISES competition and in consideration for being permitted to enter competition events sanctioned by AMERICAN MINI-CROSS ENTERPRISES If any of the statements contained in this application are found to be untrue, I agree that I am automatically suspended from AMERICAN MINI-CROSS ENTERPRISES events for a period of one (1) year. I understand this membership in NO WAY PROVIDES ME INSURANCE. And I understand it is EXTREMELY important that I HAVE MY OWN MEDICAL POLICY. We hereby make oath and say that to the best of our knowledge and belief all statements set forth in this report are true and correct. I HAVE COMPLETELY READ & UNDERSTAND THIS APPLICATION AND INDEMNITY AGREEMENT. NOTICE, IF UNDER 18 years of age or under age of majority in the applicant's residence, this application must bear the signature of parent or legal guardian which shall acknowledge a waiver and release of any and all claims such parent or guardian may have.

Parent or Legal Guardian

Have you completely read and understood this Have you completely read and understood this application and the release and indemnity application and the release and indemnity agreement? agreement? RACING CAN BE DANGEROUS DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY RECEIPT - Please retain this receipt until you receive your card_ Name: Date: Amt. Signature FOR AME INFORMATION, EMAIL KTMJ@AOL.COM OR CALL (904) 610-0197 
12685 HOLLY ST. • RIVERSIDE, CA 92509 www.ameminicross.com
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