New Membership_________  Renewal_________
Membership Fee is $10.00 per year, please make check or money order
payable to "District 12 Motocross"

In consideration of being granted a membership and in consideration of being permitted to enter events scheduled by District 12 of Ohio Motorcycle Association, Inc. and/or AMA District 12 Off Road:  I, for myself, my heirs, personal representatives and assigns, I hereby release, discharge, and agree to hold harmless, and indemnify District 12 of Ohio Motorcycle Association, Inc., AMA District 12 Off Road, the clubs and/or promoters presenting scheduled events, the owners and lessees of premises on which events take place, the participants in said events, the owners, sponsors, and manufacturers of all equipment upon the premises, and the officers, directors, official representatives, agents and employees of all of them of and from all liability, loss, claims, demands and possible causes of action that may otherwise accrue from any loss, damage or injury (including death) to my person or property in any way resulting from or arising in connection with, or related to, any event, and whether arising while engaged in competition or in practice or preparation therefor or while upon entering or departing from said premises, from any cause whatsoever including without limitation the failure of anyone to enforce rules and regulations, failure to make inspections or the negligence of other persons.  I know the risk and danger to myself and property while upon said premises or while participating or assisting in an event, and I do so voluntarily and reliance, not upon the property, equipment, facilities and existing conditions furnished by others, but upon my own judgement and ability, and thereby assume all risk of loss, damage or injury (including death) to myself and my property from any cause whatsoever and whether or not attributable to the negligence of others.  I hereby certify that I am not an agent or employee of District 12 of Ohio Motorcycle Association or AMA District 12 Off Road and I assume all responsibility for all charges, premiums and taxes, if any, payable on any funds that I may receive as a result of my competitive activities, including without limitation Social Security taxes, unemployment insurance taxes, compensation insurance, income taxes and withholding taxes.  I understand that a District Membership is subject to District 12 of Ohio Motorcycle Association, Inc. and AMA District 12 Off Road rules for all events.   

Have you completely read this application?  ______________  We hereby make oath and say that to the best of our knowledge and belief all statements set forth in this application are true and correct.