SoCal OTMX

MEMBERSHIP APPLICATION FOR THE YEAR 2019

Membership fee: $35 ($20 after July 1st, $10 after October 1st)
 

IMPORTANT: Being at least 40 years of age before the end of the racing year of this application is the primary requirement for becoming a member of the SoCal OTMX. If you are a new member, please email a copy of your driver’s license to edthemotohead@ca.rr.com in order to verify your age.

ABOUT RIDING NUMBERS:
Riding numbers 1-10 are earned and non-transferable; numbers 11-100 are earned and cannot be assigned without the specific permission of the rider who earned the number. Earned numbers must be claimed by application renewal no later than January 30th. After January 30th, unclaimed earned numbers may be reassigned). THE EARNED NUMBER LIST WILL BE AVAILABLE ON THE CLUB WEBSITE JANUARY 10TH). THREE DIGIT NUMBERS ARE AVAILABLE ON A FIRST-COME FIRST-SERVED BASIS AFTER JANUARY 10TH; TO RETAIN YOUR 3-DIGIT NUMBER FROM 2018 YOU MUST SEND IN YOUR CLUB RENEWAL BEFORE JANUARY 10TH!

Members have their name and riding number listed in a roster on our website to show who is a member and what numbers are taken. Would you like more info shown so members can contact you?


Please make check payable to: SoCal OTMX, Inc.

Mail to check to:
SoCal OTMX, Inc. c/o Eddie Johnson
96 Stardance
Mission Viejo, CA 92692

Please fill-out and submit the following Membership Application.

Membership Type *
Name *
Name
Birthdate (see important age requirements above) *
Birthdate (see important age requirements above)
Address *
Address
Phone *
Phone
Emergency Contact Phone Number *
Emergency Contact Phone Number
See important note about riding numbers above.
Members have their name and riding number listed in a roster on our website to show who is a member and what numbers are taken. Would you like more info shown so members can contact you?
Show the City Where I Live *
Show My Phone Number *
Show My Email Address *
WAIVER, INDEMNIFICATION & RELEASE OF LIABILITY & AGREEMENT RELATING TO THE "SoCal O.T.M.X. ASSOC." I the undersigned, do hereby for myself, my heirs, executors & assigns, release, remise & forever discharge & agree to indemnify & hold harmless the "SoCal O.T.M.X. Assoc." & its officers, agents, & employees, of & from any & every claim, demand action or right of whatsoever kind of nature & any cost, loss or expense in connection therewith arising from participation in any events sanctioned by the "SoCal O.T.M.X. Assoc.", or any related facilities, including any claims or demands for injury to or death of any persons or any damage to or destruction of any property resulting from or claimed to result from or arise out of any accident or occurrence during or in connection with said events including specifically such as may arise out of or be claimed to arise out of negligence on the part of said "SoCal O.T.M.X. Assoc.", its officers, agents, or employees. I further agree that the "SoCal O.T.M.X. Assoc." shall not be liable for loss, injury or damage caused to the rider resulting from: (A) An act, omission, or order of the motorcycle owner or the owner of the motorcycle or equipment or the servant, agents or employee of either the motorcycle owner or the owner thereof (B) The nature of the article, or ant defect, characteristic, or inherent vice thereof, including susceptibility to damage because of atmospheric conditions such as temperature & humidity, or change therein. (C) Earthquake, flood, & rising waters, or other act of God. (D) Fire, explosion, lightning, windstorm, tornado, cyclone, hurricane, collapse of building or sprinkler tanks, fall of elevators, leakage or failure of sprinkler systems. (E) Strikes, lockouts, labor disturbances, riots, civil- commotion, or the act of any person or persons taking part in any such occurrence or disorder. (F) The condition of the land upon which the race is conducted or the condition of the racecourse. I UNDERSTAND THAT MEMBERSHIP IN THE SoCal O.T.M.X. ASSOC. DOES NOT IN ANY WAY INCLUDE OR GUARANTEE TO ME ANY INSURANCE COVERAGE OF ANY KIND. I have read the foregoing waiver, indemnification & release & fully understand that no officer or agent or employee of the "SoCal O.T.M.X. Assoc." is authorized to vary me terms or provisions of this instrument or to make any representations contrary to the provisions hereof. I have received, reviewed, & understand the rules & regulations of this club & hereby agree to abide by said rules & regulations. I HAVE READ AND UNDERSTAND THE ABOVE WAIVER, INDEMNIFICATION & RELEASE OF LIABILITY & AGREEMENT RELATING TO THE "SoCal O.T.M.X. ASSOC.
Sign (or enter your name if filled-out online)
For club use only – DO NOT fill-out
Received By Date SoCal Member Number
Riding Classification Official Riding Number Assigned