Cycle News is a weekly magazine that covers all aspects of motorcycling including Supercross, Motocross and MotoGP as well as new motorcycles
Issue link: https://magazine.cyclenews.com/i/125845
• ~-------------------- -- - ---- ---- - - ------- - GREAT BEAR G.P. P.O. Box 6026 Orange, Ca. 92667 NOV ICE DESERT 0 AMATEUR MOTO·X • • "'" '\, - 100 101 - 175 EXPERT SCRAMBLE PWDR·PUFF ' ?r )jrJ ~O 251 - 500 Phone (714) 636-0CMC or (714) 636-6262 , 50 1 - 650 HACKS !) OPEN OLD TIMER D IST . No . " ~A RID ERS PL EASE CH ECK CORRECT BOX Mail Entry $10.00 a ri der - Post Entry $100.00 ENTRY MUST BE ACCOMPAN IED BY 2 SELF A DDR ESSE D, STAMPED, LEGAL SIZE ENVELOPES Dist. No . _ Eng. Size Club, Make Bike AMA# Address _ Name Phone ' ~ _ G) I~ _ Expires '1~ ~ ~ PL EASE PRINT CLE A R L Y I \ ~~ ~ . ~;(I'J'\ ~ 176 - 250 UNCLASS Age - - - -- - - - rr; UJ I T H E UN DERSIGNED EN TRANT BY AFF IXING HIS IN IT I A L S BELOW, ACKNOWLEDGES THAT HE ASSUMES T H E RISK OF ANY LOSS F R O M INJUR Y OR PROPERTY DAMAGE TO HIMS ELF OR TO OTHE RS , D UE TO HIS PAR T IC IPATIDN IN TH IS EVENT AN D HE HEREWITH SPECIF ICALLY HOLDS HARMLESS FROM ANY S AI D LOSS THE AMER ICAN MOT O RCYCLE ASSOCIATION , SPOR T S COM M ITTEE , D IS TRICT 37 AMA, IN C .. T H E SPONSORING CLUB OR ORGAN IZAT ION , A ND T H E OWN ERS OF TH E REA L PROPER T Y ON WHICH SA ID EVENT SHALL TAKE PLACE . 1-3 '5;> S~ ~~ . ~!\) ~~ ' ~ ~ = t:fJ ::a = c: .., t.J:j ::a :l: > en =-- ~ =~ .., :z: I--t :DIto rn .- =e I--t (entrant's end/Of" parent's In i t ia ls) ::a ~ The un d e r sig n ed d oes h e r e b y cert if y th a t h e is II duly Qu alif ied (C irc le One) Amateu r /E)(pert/Nov ice c l a s s motorc y cle r id e r h 8 v ing been 80 q u a li f ie d by a competent organization . It is further u n derstood end agreed that i n the event I am i n jured from what.aever caus e during the e ven t covered by th is app l icat io n , I herewith consent to and authorize f irst lI id and II m b u l a nce serv ice 8S provided by the sponsoring club or property owner. a n d f u rt h e r hold a ll parties h a rm less from any c o n s eq u ences of s a id a ld . U n der the rules a nd sa n ct ions o f t h e Amer ic an Motorcycle A ssoc ls t lon . I hereby ag ree to conform a nd com p l y w ith the ru l es govern in s th i s con t e s t . Signature o f entran t: _ De te , 19 nN ~~ _ If entrant i s under 18 and does no t have a curre nt D t ri ct 37 Ca rd indicating notarized is consen t i s on file, Pa rent or G uardi an must si gn here acknow edgi ng his or her notarized l consent to the terms of entry . !1 ... M A L E/ FEMA L E RID ER S N AM E AGE G.P. No . I STRE ET A DD RESS I YOU R INSU RA NCE COM PAN Y I I ~ • I PHONE RELATI ONS HIP ~ YOU R BL OOD TY PE h POLICY NU MBER J, ~ o PHON E I PERSON T O NOT IF Y IN CASE OF ACCIDEN T I ) STATE CIT Y rn , ~ ~ , Feb ruary 12, 19 74 CYCLB NB" S