Gran Prix Racing Sponsored By:

SWAMP CREEK MC & Sanctioned BY OMRA

Rider Information

If you want us to get the info correct- Write so we can read it!!!

Rider Name: Age:

Address: Phone:
City: State: Zip:

MAKE OF BIKE CC:

KAW KTM SUZ HON YAM OTHER

Class A-EXP B- C-
INT BEG
AA AA

OPEN X A K

(any CC)
200, Z E B

2 Stk,

250 4- Stk
30 U D T

40 V F C

50 R Y

60 Q

70 P

Women W
 Sportsman S

Junior JA JB JC

PLEASE CIRCLE YOUR CLASS

Release:

I, hereby release, and agree to hold harmless Swamp Creek MC, OMRA, the Promoters, the land owners, the land lessees, the participants,
sponsors, the officers, directors, officials, representatives, agents and employees of all of them, of and from all liability, loss, claims and demands
that may occur from any loss, damage or injury (including death, loss of limbs and permanent disablement) to my person or property, in any way
resulting from, or arising in connection with this event and whether arising while engaged in competition or in a practice or preparation therefore,
or while upon, entering or departing from said premises from any causes whatsoever. I know the risk and danger to myself and property while upon
said premises or while participating or assisting in this event, so voluntarily and in reliance, upon my own judgment and ability and I thereby assume all risk
for loss, damage or injury (including death, loss of limbs and permanent disablement) to myself and my property from any cause whatsoever.

Agreement: By my signature below, I hereby agree to the terms of the above release and further agree to abide by the OMRA rule book and any special
regulations of Swamp Creek MC during this event.

Rider Signature

Date