Series Registration

                            Please complete the following information.

                                                    Racer Information

* First Name                 

* Last Name                 

* Address                     

* City                             

* State                          

* Zip Code                   

* Date of Birth              (mm-dd-yyyy)

* Phone Number          (aaa-bbb-cccc)

* Emergency Phone    (aaa-bbb-cccc)

E-Mail Address          

        I'm just signing up to be a member of ATVCCS (not a racer).

             If you checked this box then you can skip to the bottom of this

             form.

Jacket / Jersey Size      Youth Small Youth Medium Youth Large XL Large Medium Small

Helmet Size                    Youth Small Youth Medium Youth Large XL Large Medium Small

Race Machine                Honda Yamaha Suzuki Kaw KTM Can Am Polaris Apex ARC ATK DRR Other

List your top three desired race numbers.             

        ATVCCS may release my mailing info to third parties related to off-road racing.

                                                 Select Class/Classes

                                                 Racer Classification

A Program                                             Expert A

(Expert / Intermediate)                          Intermediate A                

B Program                              Intermediate B                        35+ B

(Amateur)                                  Amateur B                              45+ B

                                                   Junior B                                   Utility B

C Program                                           Masters (50+) C

 (Lady / Age)                                          Lady Open C

                                                                Lady 30+ C

                                                                Youth C (16 under)

Sportsman                                          Sportsman A

                                                               Sportsman Stock

                                                               Sportsman B

                                                               Sportsman Utility

Pee Wee Program              7 Under        10 Under     12 Under

                                                    I will require a transponder.  Note: if you still

have a tag from previous races you can still use that same tag in 2010.

Competition registration fee is $20.00 for the first class entered and $10.00 for

each additional class entered.  Transponder Fee is $30.00 per class.