2007 USRA DESERT ONLY APPLICATION .................................................Click Here to get back to the www.raceUSRA.com

Send to: Lila Lundgreen 9584 No Elk Ridge Dr, Eagle Mountain, Ut 84005
Send self Address Stamped Envelope to have card mailed back to you!!!    

PLEASE PRINT ___ Full Year $25.00 ______Day Pass $5.00

NAME_________________________________ B-DATE____________PHONE #________ ______

ADDRESS________________________________________________________APT #__________

CITY____________________________________ ____STATE___________ZIP _____ ______

E-mail address__________________________AGE ____SEX ___ CLUB ________ COAT SIZE___

SPARK ARRESTORS ARE REQUIRED

CAUTION: READ BEFORE SIGNING

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

I, the undersigned, for myself and for my heirs, personal representatives and assigns, do hereby release and forever discharge Utah Sportsman Riders Association Inc. and any other person, firm, or corporation charged or chargeable with responsibility or liability, their heirs, representatives and actions and causes of action, arising from any act or occurrence, and particularly on account of all personal injury disability, property damage, loss damage of any kind that I may hereafter sustain as a result of participating in an event named as USRA sanctioned.

I fully understand the nature of the activities to be conducted by Utah Sportsman Riders Association Inc., acknowledge the hazards of said activities and voluntarily assume the risk of injury to my person, property of others. Your membership does not in anyway include or guarantee to any insurance coverage of any kind. Insurance if any, provided by a USRA sanctioned club, is without cost to you and maybe increased, decreased, canceled or changed in any way by the sanctioning USRA club at any time at its sole discretion.

THE USRA RESERVES THE RIGHT TO REFUSE OR REVOKE MEMBERSHIP TO ANYONE.

IF MEMBER IS UNDER THE AGE OF 18 YEARS, THIS FORM MUST BE SIGNED BY HIS OR HER PARENT OR LEGAL GUARDIAN.

PLEASE SIGN

Date: _______________

MEMBER SIGNATURE: ______________________________________________________________________

PARENT /GUARDIAN: _______________________________________________________________________

BIKE BRAND____________BIKE SIZE CC________ 2 Stroke / 4 Stroke

DESERT ONLY USRA #_________________

CHECK ONE: ____ EXPERT ____AMATEUR ____NOVICE ____SPORTSMAN

CLASS: ___65 A (10-12) ___65 B (7-9) ___85 ___SCHOOL BOY ___POWDER PUFF

__BEG WOM ___WOMEN ___125/200 ___250 ___OPEN (280CC+) ___OVER 25
___4 STROKE ___OVER 30 ___OVER 35 ___OVER 40 ___OVER 45

___OVER 50 ___ATV A ___ATV B ___ANTIQUE