2003 Iron Butt Rally Registration Form

Have you worked on a previous Iron Butt Rally? If yes, what year and job did you perform?
If you believe you have a "pass" on the drawing that you obtained via a supporting 24 hour rally, please indicate the year and rally: ______ (for example, 2002 ButtLite III)
We will confirm your entry as soon as the supporting documents are received from the rallymaster of that rally. If you are unsure of your status, do NOT contact the Iron Butt Association, contact the rallymaster from the event you received the pass on the drawing.
NAME:
ADDRESS:
Please provide the Iron Butt Rally Committee with phone numbers and the best time of day to reach you:
WORK:
HOME:
OTHER:
If you have one, an e-mail address:
Make, model and year motorcycle you intend to ride in the Iron Butt Rally (we realize that this subject to change):
MAKE:
MODEL:
YEAR:
Rider Profile: please list your age, riding experience, occupation and just about anything else you can tell us for about yourself (some of this information may be used for press inquiries, please indicate if something is personal and may not be shared with the outside world):
Please read carefully!
By signing and submitting this document or by e-mailing it, I acknowledge the following:
1. / My awareness that if I am chosen, the $500 deposit that is required to be paid by January 15, 2003 is not refundable if I am unable to participate in the rally for any reason and that I may NOT sell my position in the rally;
2. / I have studied accounts of the 1995, 1997, 1999 and 2001 Iron Butt rallies and I am familiar with the risks associated with participating in the Iron Butt Rally;
3. / That I possess sufficient skill, training, experience, and health to engage in this event;
4. / That I have read the 2001 edition of the Iron Butt Rules and I understand the basic rules of fair play;
5. / That pursuing optional bonuses may involve crossing international borders with all the risks such crossing may contain;
6. / That long-distance motorcycle touring is a dangerous activity and should not be undertaken except by competent, experienced individuals;
7. / That I will almost certainly be subjecting myself during the course of this event to hazards above and beyond those faced by ordinary motorcyclists;
8. / That I will face dangers on this event beyond the control of the rallymaster, his agents, servants, and/or assignees;
9. / That I am solely responsible for my own conduct during the course of the rally; and
10. / That I sign this acknowledgment as my own act and of my own free will, absent any misunderstanding on my part about the nature, risks, and hazards to myself and others of endurance motorcycle riding in general and this event in particular.
11. / I also agree to the use of any photos, slides, videotapes, motion picture film, computer images, electronic or written mail, etc. that will be taken of me, or written about me, for future use in promotional and/or informational activities as deemed appropriate by any of the management of the Iron Butt Rally.

Signature of Applicant

/ Printed Name / Date
Place "via e-mail" on above line if sent in using e-mail.
Return this completed application to:
Iron Butt Association,
2003 Iron Butt
Rally Drawing,
P.O. Box 308,
Berwyn, IL 60402 USA
OR e-mail it to

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