2006 OFFICIAL ENTRY FORM

BRANSON USA MOTOCROSS CHAMPIONSHIPS

Rider's Name

Address

City

Phone #

(area code)

State

Birthdate

Zip

Age

 (AGE CLASSES ARE AS OF 10-12-06 - EVENT 1ST DAY!)
Insert Bike Number
in Space Below:

Pee Wee

Jr. Cycle

Mini Cycle

Motorcycle

ENTRY FEE: THE ENTRY FEE FOR ALL CLASSES WILL BE $60.00 PER CLASS PER ENTRY.  (MAIL DEADLINE 10-1-06)
I HAVE A  2006  LIC FOR:
 NMA
  GNC
 SRAC
 AMA
   
(If no license, add $5.00 to entry fee for each class entered) POST ENTRY FEES: ALL ENTRIES NOT POSTMARKED BY 10/2/06 WILL BE SUBJECT TO $85.00 POST ENTRY FEE

CHECK BIKE BRAND YOU ARE RIDING:

 SUZ
 KAW
 YAM
 KTM
 HUSQ  HON
 COBRA
   Other
 POL
   
MARK CLASSES YOU ARE RIDING (10 required to make a class)
 Pee Wee Stk 4-6
 Pee Wee Stk 7-8
 Pee Wee Mod 4-6
 Pee Wee Mod 7-8
 Super Pee Wee 6-9
 65 Jr. Cycle Stk 6-8
 65 Jr. Cycle Mod 6-8
 65 Jr. Cycle Stk 9-11
 65 Jr. Cycle Mod 9-11
 65 Jr. Cycle OPEN thru 11
 85 Stk through 11
 85 Mod through 11
 85 Stk 12-13
 85 Mod 12-13
 85 Stk 14-16
 85 Mod 14-16
85 OPEN thru 16
 Super Mini Mod thru 16
 125 Pro (A)
 125 Inter (B) Stk
 125 Inter (B) Mod
 125 Nov (C) Stk
 125 Nov (C) Mod
 125 Beginner
 125 Open (Non Pro)
 250 Pro (A)
 250 Inter (B) Stk
 250 Inter (B) Mod

NO RIDER MEDICAL INSURANCE PROVIDED

 250 Nov (C) Stk
 250 Nov (C) Mod
 250 Beginner
 250 Open (Non Pro)
 Women 65-85cc thru 16
 Women 125-250cc Non Pro
 125 2 Stroke Only Non Pro
250 4 Stroke Only Non Pro
 450 4 Stroke Only Non Pro
 Plus 25
 Plus 30
 Plus 35
Plus 40
Plus 50
BEGINNER CLASS: Racing 1 year or less
NOTE: "PLUS" classes race on Sunday only.

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

IN CONSIDERATION of being permitted to compete, officiate, observe, work for, or participate in any way in the EVENT (S) or being permitted to enter for any purpose any RESTRICTED AREA (defined as any area requiring special authorization, credentials, or permission to enter or any area to which admission by the general public is restricted or prohibited), EACH OF THE UNDERSIGNED, for himself, his personal representatives, heirs and next of kin:

1. Acknowledges, agrees, and represents that he has or will immediately upon entering any of such RESTRICTED AREAS, and will continuously thereafter, inspect the RESTRICTED AREAS and/or refuse to participate further in the EVENT(S).

2. HEREBY RELEASES WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any RESTRICTED AREA, promoters, sponsors, advertisers, owners and lessees of premises used to  conduct the EVENT(S), premises and event inspectors, surveyors, underwriters, consultants and others who give recommendations, directions or instructions or engage in risk evaluation or loss control activities regarding the premises or EVENT(S) and each of them, their directors, officers, agents and employees, all for the purposes herein referred to as "Releasees,", FROM LIABILITY, TO THE UNDERSIGNED, his personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THERFOR ON ACCOUNT ON INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I HAVE READ THE ABOVE ASSUMPTION OF RISK ACKNOWLEDGMENT, UNDERSTAND WHAT I HAVE READ AND SIGN IT VOLUNTARILY.

_____________________________________       _____________________
Rider's Signature                                                               Date

______________________________________     _____________________
Parent or Legal Guardian's Signature                             Date
(if under 21)

ENTRY DEADLINE POSTMARK: OCT 2, 2006

MAIL ENTRIES WITH CASHIERS CHECK OR MONEY ORDER PAYABLE TO: Branson USA (U.S. funds only)

BRANSON USA
P.O. BOX 757
PERRIS CA 92572-0757