RIDER ELIGIBILITY

To be eligible for a 2017 AMA Pro Racing Motocross License, applicants must be at least 16 years of age at the time of application and meet one of the following criteria: (Check applicable box) * 
Choose One: *
If renewal, use last years headshot? *

MEDICAL/HEALTH INSURANCE

I/Applicant hereby certify that I have medical/health insurance coverage effective all dates of the series event(s) and that the information provided below is accurate. In the event said medical/health coverage is not applicable or effective, I certify and acknowledge I will be held solely responsible for all medical costs that may be incurred as a result of injuries sustained at the event. *

 

IMPACT CONCUSSION TEST


 

PURSE PAYMENT

ALL RIDERS are required to upload a voided check. Please remove a check write VOID across the check take a picture of the check (make sure legible and void does not cover any of the numbers at the bottom of the check) upload below. 
 
FOREIGN RIDERS must have a PayPal account created for transfer of funds directly to your account. Alternative methods are available upon request.
 
Either of the requirements above is MANDATORY. We will not issue checks, it is your responsibility to provide use with the correct information. 

 
IRS FORMS:  One of the following IRS forms must be submitted.  Purse earnings may be issued in the name of the Rider or in the name of a company/business in lieu of the Rider personally.  In order to issue payment to a company, the proper company/business name, address, account information and FEIN (federal employer identification number) must be submitted on the IRS form in lieu of that of the Rider.

Riders earning $600 and more in annual purse earnings will receive a 1099-MISC tax form from MX Sports Pro Racing.

Click on the applicable link(s) below to download the applicable IRS form, save to your computer, complete, save again (if you cannot save as PDF, save as XPS) and upload in the box provided below. Taking a picture of the completed form with your phone and uploading is acceptable as well.

Form W-9 (For U.S. citizens, Resident Aliens and businesses)

Form 8233 (Exemption from withholding on compensation for Non-Resident Aliens) 


 

CREDENTIAL PHOTO


 

2017 MXS ALL-EVENT RELEASE, WAIVER AND INDEMNITY AGREEMENT

IN CONSIDERATION for MX Sports Pro Racing, Inc. (“MXS”) allowing me (or in the case of a minor, ‘my minor child’) to (a) compete, officiate, observe, work for, or participate in any way in the events produced and/or promoted by MXS during calendar year 2017 or in any related activities, whether events are professional motocross races or other entertainment events (collectively, “Event(s)”); or (b) enter, for any purpose, any restricted area requiring authorization, credentials, or permission to enter or where admission of the general public is restricted, including but not limited to, the competition and pit areas (“Restricted Area(s)”), I ACKNOWLEDGE and AGREE that, AS TO EACH SUCH EVENT, I: 

  1. Will immediately upon entering any Restricted Areas and continuously thereafter, inspect such areas, and if at any time I feel any part of Restricted Areas to be unsafe, I will immediately so advise the Event officials and will leave and/or refuse to participate further in the Event(s). 
  1. (i) UNDERSTAND that THE EVENT(S) MAY BE VERY DANGEROUS and may involve the risk of SERIOUS INJURY or DEATH and that the INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS; (ii) ASSUME FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE ARISING OUT OF OR RELATING TO ANY EVENT, AND FOR ALL LIABILITY TO ME and my personal representatives, assigns, heirs, next of kin or wards; and (iii) AUTHORIZE AND PROVIDE FULL CONSENT TO RELEASEES, as defined in Paragraph 3 below, to seek and/or provide medical attention/treatment, as each may deem necessary, if I am unable, unfit or not qualified to make such. 
  1. RELEASE, WAIVE AND DISCHARGE MXS, their respective parents, affiliates and related companies, and their respective representatives, officers and employees and those in privity with them including, without limitation, any co-promoters, sponsors, participants, television partners, racing associations, sanctioning organizations or any subdivision or affiliate thereof, track operators, owners, builders and construction companies, officials, motorcycle owners, racers, pit crews, rescue personnel, trauma doctors and other medical personnel, any persons in any Restricted Area, promoters, advertisers, owners and lessees of premises used to conduct the Event(s), inspectors, surveyors, underwriters, risk evaluators, consultants and others who provide recommendations, directions, or instructions including, but not limited to, driving schools or classes, and each of them, their directors, officers, agents and employees (collectively, “Releasees”) FROM ALL LIABILITY TO ME and my personal representatives, assigns, heirs, and next of kin or wards FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMAND ON ACCOUNT OF DEATH OR INJURY TO PERSON OR PROPERTY, ARISING OUT OF OR RELATED TO THE EVENT, WHETHER CAUSED IN WHOLE OR IN PART, BY THE SOLE OR CONCURRENT NEGLIGENCE OF THE RELEASEES OR OTHERWISE, including, without limitation, NEGLIGENT RESCUE. 
  1. AGREE TO INDEMNIFY, DEFEND, AND SAVE AND HOLD HARMLESS the RELEASEES and each of them FROM ANY claim or demand brought by or on behalf of me for any LOSS, LIABILITY, or DAMAGE arising out of or related to the EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, INCLUDING WITHOUT LIMITATION, ATTORNEY’S FEES, LITIGATION EXPENSES AND COURT. 
  1. GRANT to MXS, and its related or affiliated entities and their respective employees, agents, licensees, successors and assigns (collectively, “Grantees”), permission to photograph, film, videotape or otherwise record my voice, image, or likeness in connection with any Event (collectively, “Appearance”), and to use the Appearance in advertising, publicity, promotional, merchandising and/or other commercial activities of Grantees, and agree that Grantees shall be the exclusive owner of all copyright and other rights in and to all works incorporating any or all of the Appearance, and all allied, ancillary and subsidiary rights relating thereto, and will be able to perpetually use and license to third parties such works in all media currently existing or hereafter created, including, but not limited to, printed materials, television and all electronic media, for any use to which the same or any material therein may hereafter be put, applied or I further acknowledge that (i) Grantees are not required to use the Appearance in any way; (ii) Grantees may transfer, assign or sublicense their rights and privileges hereunder to any entity or individual without restriction; (iii) in no event shall I have the right to enjoin the development, production or distribution or exploitation of material incorporating any or all of the Appearance; (iv) the consent of no other person, firm, corporation or labor organization is required to enable Grantees to use the Appearance; and (v) the use by Grantees of the Appearance will not violate the rights of any third party or any rights that I may have as a result of any membership in any labor organization. Additionally, I forever RELEASE AND DISCHARGE Grantees from any and all actions, counter or cross actions, claims, demands, damages, costs, attorneys’ fees and expenses of any kind whatsoever (collectively “Claims”), which may now exist or hereafter arise, including but not limited to, Claims relating to the rights of privacy and publicity arising out of or related to use of the Appearance, or any part thereof, and further agree that I shall be liable for any attorneys’ fees and costs incurred by Grantees or any one of them in connection with any claim or lawsuit filed notwithstanding the terms of this release. 
  1. HEREBY AGREE THAT THIS ALL-EVENT RELEASE, WAIVER AND INDEMNITY AGREEMENT extends to all acts of negligence by the RELEASES, INCLUDING NEGLIGENT RESCUE OR MEDICAL OPERATIONS and is intended to be as broad and inclusive as is permitted by the laws of the Municipality, State and/or Country in which the EVENT(S) is/are conducted. I further authorize all event medical personnel to release to MXS officials all information regarding my medical condition or any injuries I may sustain at any of the events. 
  1. Understand that if any portion hereof is held invalid, the balance shall, notwithstanding, continue in full legal force and

I HAVE READ THIS ENTIRE RELEASE AND FULLY UNDERSTAND ITS TERMS AND ACKNOWLEDGE THAT I AM GIVING UP SUBSTANTIAL RIGHTS. BY SIGNING AND CLICKING THE BOX BELOW, I VOLUNTARILY, KNOWINGLY AND WILLINGLY, WITHOUT ANY INDUCEMENT, AGREE TO THE TERMS AND CONDITIONS HEREIN, AND ACKNOWLEDGE MY ACCEPTANCE OF A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

 

I agree to the above terms and conditions and that all the information I entered is accurate to the best of my knowledge. *
Digital Signature *
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