SIGN ME UP!
2004 SUZUKI MOTOCROSS CONTINGENCY RELEASE/ENROLLMENT APPLICATION
In consideration of being permitted to participate in the Suzuki Contingency Program during the 2004 season, I (PRINT NAME)
______________________________________, for myself, my successors, heirs and assigns, release and forever discharge American
Suzuki Motor Corporation ("ASMC") and its affiliates, agents, employees, servants, officers, directors, and authorized SUZUKI dealers ("related parties")
from all claims, actions, or judgements I may have or claim to have against ASMC and related parties. I agree that I am responsible for all personal injuries,
including death, and injuries to property, real or personal, caused by or arising out of my participation in the Suzuki Contingency Program for 2004.
I further agree for myself, my successors, heirs and assigns to indemnify and hold ASMC and related parties harmless from all claims and suits for
personal injuries, including death, and damages to property caused by my act or omission arising out of my participation in the Suzuki Contingency
Program for 2004, and from all judgements recovered and from all expenses incurred in defending said claims or suits.
I further agree that without compensation, my name, as well as any photographs, pictures, slides, or movies taken of myself or made in connection with
my participation in the Suzuki Contingency Program for 2004, or any reproduction of the same, may in any manner be used by ASMC, or by any person,
corporation or association authorized by ASMC.
I am in good health and have no physical conditions that would prevent me from participating in motocross racing.
I understand that contingency payments will not be made to classes that have fewer than seven (7) riders. Only 2003 and 2004 U.S. RM/RM-Z models
are eligible for motocross contingency. Racers must own the motorcycles raced in the contingency races in order to receive payment. I agree to include
proof of ownership*. I agree to complete this contingency application and submit it to ASMC within 30 days of my first event, to qualify for payment. I
agree that applications postmarked after the 30 day period will not be eligible for payment. I understand that it is my responsibility to resolve
race result disputes with the race organization. ASMC will only make payments based on results sent by the race organization.
I HEREBY UNDERSTAND that Section 1542 of the California Civil Code states that a general release does not extend to claims which I do not know exist,
or do not suspect exist at the time of signing the release, and which, if I knew or suspected such claims exist, would have materially affected my willingness
to sign the release. However, I HEREBY WAIVE MY RIGHTS under Section 1542 of the Civil Code of California and any similar law of any other
state, and acknowledge that this waiver is an essential term of this release (applicant's signature, or signature of parent or guardian if applicant is under
18 years of age).
Signature _______________________________________________________________________________________
I, the undersigned, certify that the name, social security number and address listed are correct as they relate to the Internal Revenue Service Form W-9.
Riders collecting Suzuki contingency subject to IRS Form 1099.
PLEASE COMPLETE IN FULL DETAIL:
Racer's Social Security Number: _________-________-___________ E-Mail Address _________________________________
Print name CLEARLY ________________________________ Age _____ Date of Birth _________ Phone (____) ____________
Street Address _____________________________ Apt. # ____ City _______________________ State ___ Zip __________
*Sponsored riders need to complete the "Sponsored Rider Affidavit" on reverse side.
PLEASE TURN OVER TO COMPLETE APPLICATION
