Loretta Lynn's Regional Refund Request

Regional or National: *

Racer or Spectator: *

Refund or Transfer: *

Date of Birth * +

AMA # *

Racer First Name *

Racer Last Name *

Mailing Address *

City *

State *

Zip Code *

Email Address *

Cell Phone Number *

REGIONAL REFUND OR TRANSFER

Select the Class to be refunded. If transfering to another Regional or other extenuating circumstance, please explain.

Class 1 *

Region to Refund/Transfer *

Class 2

Region to Refund/Transfer

Class 3

Region to Refund/Transfer

Class 4

Region to Refund/Transfer

Class 5

Region to Refund/Transfer

Class 6

Region to Refund/Transfer

REASON FOR REFUND/TRANSFER *

REFUND POLICY

By submitting this form you are confirming withdrawal or transfer of class, and that you are either the rider or a legal parent/guardian of the rider. You also confirm that you have read and understand the Refund Policy, as well as the deadlines for requests as listed on our website www.mxsports.com.

Digital Signature *

clear

Print Your Name *

Relationship to Rider *

DATE * +