JEFFERSON AREA MOTOR SQUAD

EVENT REGISTRATION FORM

LIABILITY WAIVER:
The below named participant agrees that he/she is participating voluntarily in this training seminar and agrees to release and hold harmless all persons and organizations including but not limited to: the County of Albemarle, the City of Charlottesville, the University of Virginia, the Albemarle County Police Department, the Charlottesville City Police Department, the University of Virginia Police Department, The DoubleTree Hotel, Sams Club, the Boys and Girls Club of Charlottesville, and all of their officers, directors, and employees for any loss, cost, injury or damages that may be suffered as a result of participation.

The participant understands and agrees that there are inherent risks of participation including bodily injury or death and freely and knowingly assumes such risks.

BY FILLING OUT THE FORM BELOW AND CLICKING ON THE "SUBMIT" BUTTON, I AFFIRM THAT I HAVE READ AND AGREE WITH THE ABOVE WAIVER.

*Event participants will also be required to sign this or a similar waiver in person prior to participating in the event.

REGISTRATION: $100.00 PER RIDER--INCLUDES BANQUET

(Check payable to Jefferson Area Motor Squad or pay online by clicking Paypal Button)

I will be competing on: *

Harley Davidson FLH w/windshield

Harley Davidson FLH w/fairing

All others (BMW, Honda)

I plan to compete in (check all that apply)... *

Individual Slow Ride (see rules, if no team)

Expert Division

Novice Division (new or eligible riders, see rules)

T-Shirt Size *

I plan to attend the banquet *

If yes, how many will attend?

Department Affiliation *

Address *

City, State, Zip

Name: *

Email: *

Check here to receive email updates

Phone *

JEFFERSON AREA MOTOR SQUAD