Membership

Club Membership

YOUR DETAILS

Name

First

Last

Date of Birth

Age

Gender

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Emergency Contact

Name

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Last

Phone

CAUTION: READ BEFORE SIGNING

I, the undersigned, for myself and for my heirs, personal representatives and assigns, do hereby release and forever discharge Bonneville Off-Road Racing and any other person, firm, or corporation charged or chargeable with responsibility or liability, their heirs, representatives and actions and causes of action, arising from any act or occurrence, and particularly on account of all personal injury disability, property damage, loss damage of any kind that I may hereafter sustain as a result of participating in an event named as B.O.R. sanctioned. I fully understand the nature of the activities to be conducted by Bonneville Off-Road Racing, acknowledge the hazards of said activities and voluntarily assume the risk of injury to my person, property of others. Your membership does not in any way include or guarantee to any insurance coverage of any kind. Insurance if any, provided by a B.O.R. sanctioned organization, is without cost to you and maybe increased, decreased, canceled or changed in any way by the sanctioning B.O.R. organization at any time at its sole discretion. THE B.O.R. RESERVES THE RIGHT TO REFUSE OR REVOKE MEMBERSHIP TO ANYONE. IF MEMBER IS UNDER THE AGE OF 18 YEARS, THIS FORM MUST BE SIGNED BY HIS OR HER PARENT OR LEGAL GUARDIAN.