Nonrefundable Entry Fee is $550.00. A deposit of $250 is due with your entry. The balance of $300 is due no later than March 1, 2002. After March 1, 2002, payment in full is due with entry. Read this application, sign it, then mail to:

ButtLite III
1270 Bayard Avenue
Saint Paul, MN 55116
 

Name:   _______________________________________________

Street:  _______________________________________________

City:      _______________________________________________

State:  _________________         Zip: _______________________

email address: _________________________________________

Date of Birth:  _________/____________/________________

Phone _________________________________

Motorcycle (we understand this may change) _________________

AMA Number: _________________   Shirt Size: _______________

Prior Rally Experience: ___________________________________
 

THIS IS A RELEASE. READ CAREFULLY BEFORE SIGNING.

I understand that the Butt Lite III is a motorcycle endurance rally.  I further understand that motorcycling is an inherently dangerous activity which should only be undertaken by competent, experienced individuals.  I further acknowledge that, during the course of the Butt Lite III , I will almost certainly be subjecting myself  to hazards above and beyond those faced by ordinary motorcyclists.  I accept full and complete responsibility for my own safety during the rally. I acknowledge that motorcycling under adverse road, light, weather, rider, and traffic conditions is inherently dangerous, and could result in injury, or death. I hereby accept these risks, which I may incur or which I may cause to another as a condition of participation in the Butt Lite III, and hereby waive any and all claims I have or may have against the Butt Lite III, its organizers, agents and participants as a result of my participation in the Butt Lite III. I further agree to defend, indemnify and hold harmless the rally, its organizers, sponsors, volunteers, agents and participants from all claims asserted against them by third parties arising out of my conduct during the rally. I understand that my deposit and entry fee are non-refundable.

Signature: ___________________________________  

Date:________________________________