Smallwood Mongaup Valley FD

ATV Rally Fundraiser

(Please Print)

Operator’s Name: ______

Phone: (Home) ______(Cell) ______

Operator’s Mailing Address: ______

City, State, Zip: ______

Operator’s Physical Address (if different): ______

City, State, Zip: ______

Insurance Co. Name & Policy #: ______

Proof of Insurance is required to ride in all our events.

Email: (Please Print) ______

We will send you a registration confirmation via email.

Mail registration form and payment to:

SMV ATV

PO Box 955

Smallwood, NY 12778

From State Route 17, take Exit 104, onto Route 17B West

Pass Monticello Gaming & Raceway on the right

(5.7 miles from Exit 104 to Ballard Road)

Pass United Methodist Church on the right

Pass Sullivan County Airport on the right

Turn left onto 178 Ballard Road

.9 miles you will see the Firehouse on the left.

SMALLWOOD MONGAUP VALLEY FIRE CO.

10th Annual ATV Rally Fundraiser

The Smallwood Mongaup Valley Fire Co. 10th Annual ATV Rally will take place on June 3rd, 2017. The ride is self-guided and is approximately 30 miles long and is expected to last about 3 hours. The first group of riders will leave at about 8:30 AM. Registration deadline is 9:30 AM at the Smallwood Mongaup Valley Firehouse located on 178 Ballard Road, Smallwood, NY, 12778. All riders will be required to wear the appropriate safety gear including a helmet (DOT and/or SNELL approved), eye protection (goggles), long pants, a long sleeve shirt, over the ankle boots, and gloves. No alcoholic beverages will be permitted at any time. Only ATV’s designed to have a passenger will be allowed to carry a passenger. All riders are expected to maintain control of their ATV at all times.

Proof of insurance will be required on the day of the event. Without proof of insurance, you will NOT be allowed to ride. Completed entry form, should be provided with payment made out to SMV ATV. Payment and entry form should be mailed to: SMV ATV PO Box 955 Smallwood, NY 12778. Registration fees in the amount of $60.00 (Non refundable) per person ($30.00 for passenger)should be received no later than May 15, 2017. Registration at the day of the event will be $75.00 CASH.

An accurate account of participants is required by May 15, 2017. Proceeds will benefit The Smallwood Mongaup Valley Fire Co. Building Fund.

A light breakfast will be provided at no cost, Chicken BBQ will be provided, by the Smallwood Mongaup Valley Fire Co. after the rally.

Any questions can be emailed to:

http://www.Smallwoodfd.com

Entry Form on back side. OVER →