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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 judgments 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 judgments 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 off-road racing.
I understand that contingency payments will not be made to classes that have fewer than five (5) riders. Only 2003 and 2004 U.S. RM, RM-Z and DR-Z models are eligible for off-road
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. Contingency payment will be ecount debit card, check or certificate.
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 of Racer ______________________________________________________________________________________________________
Signature of Parent or Guardian, if applicable _____________________________________________________________________________________
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 ____________
PARENT OR GUARDIAN'S INFORMATION (IF APPLICABLE)
Print name CLEARLY ________________________________________________________________________ Phone (____) ___________________
Street Address ______________________________________ Apt. # ________ City _____________________________ State ___ Zip ____________
SIGNATURE OF RACER, AND PARENT OR GUARDIAN IF RACER IS UNDER 18
Racer ______________________________________________________________________________________________________________
Parent or Guardian______________________________________________________________________________________________________
*Sponsored riders need to complete the "Sponsored Rider Affidavit" on reverse side.
PLEASE TURN OVER TO COMPLETE APPLICATION
2004 SUZUKI OFF-ROAD CONTINGENCY RELEASE/ENROLLMENT APPLICATION
At Suzuki we want every ride to be safe and enjoyable. So always wear a helmet, eye protection and
protective clothing. Never ride under the influence of alcohol or other drugs. Study your owner's manual and
always inspect your Suzuki before riding. Always supervise young riders. The RM series motorcycles are for
closed-course events and related practices only.
