MINERAL WELLS ATV CLUB, LLC

REGISTRATION FORM

MARK CLASS

________ CLASS 1 0-90CC YOUTH 12 AND UNDER, (OEM FRAME, PIPE, ENGINE, NO FACTORY PRODUCED RACE BIKE)

________ CLASS 2 YOUTH OUTLAW 1-100CC 12 AND UNDER

________ CLASS 3 POWDER PUFF
SENIOR SENIOR 45 AND UP

________ OUT CLUTCH, STOCK UNCUT TRANSMISSION, STOCK FRAME, NO OUTBOARD DRAG PIPES)

________ CLASS 5 0-360CC 4-STROKE (STOCK UNCUT TRANSMISSION)

________ CLASS 6 0-330CC 2-STROKE

________ CLASS 7 0-500CC 4-STROKE

________ CLASS 8 0-400CC 2-STROKE

________ CLASS 9 0-1000CC 4-STROKE (SINGLE OR TWIN CYLINDER)

________ CLASS 10 0-450CC 4-STROKE (NO DIRTBIKES, NO DRAG AXLES, NO LOCK OUT CLUTCH, STOCK UNCUT TRANSMISSION, STOCK FRAME, NO OUTBOARD DRAG PIPES)

________ CLASS 11 0-700CC 4-STROKE OR 500CC 2-STROKE LIMITED (NO DIRTBIKES, STOCK FRAME, NO CLUTCH LOCK OUT, STOCK UNCUT TRANSMISSION, NO OUTBOARD DRAG PIPES, NO DRAG AXLES, NO CLUB MEMBERS OR MEMBERS BIKES)

________ CLASS 12 0-416CC 4-STROKE (STOCK UNCUT TRANSMISSION)

________ CLASS 13 0-500CC 2-STROKE OR 0-700CC 4-STROKE

________ CLASS 14 STOCK UTILITY 4-STROKE (PIPE ONLY MOD)

________ CLASS 15 SPORT UTILITY (NO NITROUS AND FACTORY STOCK FRAME)

________ CLASS 16 0-1500CC OPEN

DIRT BIKE CLASSES:
________ CLASS 17 0-100CC YOUTH 12 AND UNDER
ALL OTHER DIRT BIKES WILL JOIN THEIR APPROPRIATE ATV SIZED CLASS, EXCEPT IN THE 450CC 4-STROKE AND THE 700CC 4-STROKE/500CC 2-STROKE LIMITED. NO DIRTBIKES WILL BE ALLOWED IN THESE CLASSES.

________ CLASS 18 UTV’S: IF WE HAVE 2 OR MORE, THIS CLASS WILL BE RAN

________ CLASS 19 POWER-WHEELS: OPEN, 5 AND UNDER – $5

*MAKE AND MODEL OF ATV, BIKE or UTV:_____________________________________

LIABILITY WAIVER & RELEASE

Upon signing this Waiver & Release, I do understand that Mineral Wells ATV Club, LLC Members as a group or individually, will not under any conditions be held liable for any injuries or any kinds or nature which may occur or be received as a result of said participant’s participation I n said event, and hereby expressly waive all claims for injuries that may occur to myself or anyone I may injure, caused by myself or anyone else while being a participant, contestant, or spectator of said dirt drag event.

I acknowledge that I have read this Waiver & Release and do agree to it.

I have reviewed and will strictly observe the ATV Drag Rules and Regulations.

*PLEASE PRINT CLEARLY*

NAME OF PARTICIPANT DATE____/_____/_____

SIGNATURE PHONE NO.( ) ______-_______

**If Under 18 Years of Age; Parent Signature Required*

PRINT NAME OF PARENT/LEGAL GUARDIAN___________________________________________________

SIGNATURE OF PARENT/LEGAL GUARDIAN____________________________________________________

ADDRESS CITY STATE ZIP_______