June 1st-6th
Lake George, NY
¾¾ Please print clearly & sign waiver (passenger, too!) ¾¾ Complete one Registration Form per motorcycle. ¾¾ Additional Pre-Reg Forms available at Americade.com ¾¾ Photocopies & Faxes accepted: Update the contact info. Rider Name
Cell:
Address City
Passenger Name(s):
Zip
ST
After that date, post-register at the Holiday Inn (June 1-5). Post-entry prices are higher, availability limited.
oBike oTrike oAuto
M/C Brand Model
Last (nom)
First (prenom)
¾¾ Or, Pre-register ONLINE at www.Americade.com ¾¾ Pre-registration Deadline: envelopes postmarked by May 1.
Email:
Home: Last (nom)
First (prenom)
How did you hear of Americade?
PAYMENT OPTIONS: CREDIT CARD Fill out info below
Credit Card Info:
Mastercard
TOTAL FROM OTHER SIDE: $ _________ GIFT CERTIFICATE Credit Card or Gift Certificate Only Include GC with Pre-registration Form
Visa
Discover
Put 16 digits (don’t forget the last 4)
Your Name:_________________________________________________________ (As it appears on the card)
RELEASE AND INDEMNITY AGREEMENT
-
Expiration Date
CVV2 #
Month
Must Provide
Year
(3 digit code on back of card)
MUST BE SIGNED FOR REGISTRATION TO BE PROCESSED
I hereby give up all my rights to sue or make any claim for damages due to negligence or any other reason whatsoever against the American Motorcyclist Association and its district organizations, Americade, Inc., Fort William Henry, Holiday Inn, Charles Wood Park, Lake George Village as pertains to minitour use of Beach Rd. Pk Lot only, Town of Lake George, NY State Dept. of Environmental Conservation, County of Warren, sponsors and all other persons, participants or organizations conducting business with, or connected with, this event for any injury to property or person I may suffer, including but not limited to crippling injury or death, while participating in the event, or while I am upon the event premises. I know the risks of danger to myself and my property while preparing for and participating in the event and while on the event premises, and relying upon my own judgment and ability, assume all such risks of loss, and hereby agree to reimburse all costs to those persons or organizations connected with this event for damages incurred as a result of my negligence. Rider: My motorcycle meets NY State noise and registration requirements & I have a valid motorcycle license or permit. I am 18 or older.
o
My passenger, if any, is 18 or older.
o
If not, make an “X” in this box
o and have a legal guardian sign below.
Rider Name (Print) ________________________________________
Passenger Name (Print) ___________________________________
Rider Signature _________________________________ Date _____
Passenger Signature ___________________________ Date ______
Under 18 Person’s Name (Print) ______________________________ Guardian Name (Print) ______________________________________ Age _________ Guardian Signature ______________________________ Date _____
• Avoid Duplications: If you are re-sending a registration, please mark “duplicate” to avoid double charges. • Changes: Accepted in writing only and must be received by May 1. • Cancellations/Refunds (in writing only): Full refund less 5% if submitted more than 10 days before the event’s start. No refunds will be issued if submitted 10 days or less before start of event, unless cancellation is due to a medical emergency (must have medical documentation).
Please mail to: Americade PO Box 2205R | Glens Falls, NY | 12801 | USA 518-798-7888 | FAX: 518-798-0169