If yes, give particulars: __________________________________________________________

REGISTRATION INFORMATION: (Please print neatly)

NAME: ___________________________ AGE: _____ (Proof of age required if under 18)

ADDRESS: __________________________________________________________________

PHONE: ___________________________ e-mail: ___________________________

TYPE OF MOTORCYCLE: _____________ EXPERIENCE (years): ______________

EMERGENCY INFORMATION: (Please print neatly)

Next of Kin: ____________________________ Relationship: ________________

Address: ______________________________ Phone: _____________________

INSURANCE COMPANY: _________________ POLICY #: __________________

HEALTH CARD NUMBER: ________________

I have read the Rules and Regulations issued for this event and agree to be bound by them and by the competition Rules of the Canadian Motorcycle Association. In consideration of the acceptance of this entry or of my being permitted to take part in this event, I for myself, my heirs, executors, administrators, successors and assigns agree to save harmless and keep indemnified Atlantic Motorsport Park, A.M.C.R.A., the Canadian Motorcycle Association, the other competitors and their respective agents, officers, servants and representatives from and against all actions, claims, costs and demands in respect of injury, death, loss of or damage to my person or property howsoever caused arising out of or in connection with my taking part in this event and notwithstanding that the same may have been contributed to our occasioned by negligence of the same bodies, their agents, officers, servants or representatives.

Signature: _________________________________ Date: ______________________

Signature of parent or legal guardian (if under 18) _________________________________

Total Fee is $90.00 - 50% non-refundable deposit required. 1st come, 1st served. Max. of 50 students per school. All applicants will be notified of registration.

Send cheque or money order, in the amount of $45, payable to A.M.C.R.A. at:                               

Kirsty Waugh C/O AMCRA                                                                                                            6269 Cork Street  Apt #20                                                                                                       Halifax, Nova Scotia, B3L 1Y8

Balance of $45.00 due on day of school.

Or E-mail Application to: hondahuney@hotmail.com           or            Call Kirsty Waugh for information: (902) 453-5253

Website: http://www.oocities.org/womensridingschool