GIVE US YOUR DETAILS
CIRCLE MODEL(S) YOU RACE, AND LIST THE LAST 9 DIGITS OF YOUR FRAME VIN# (i.e., JS1RJ16A1X2100007):
EXAMPLE: RM125 RM250 DR350 Frame/VIN# 1
Y
2
1
0
0
0
0
7
RM125 RM250 DR-Z400 DR-Z400E Frame # __ __ __ __ __ __ __ __ __ RM125 RM250 DR-Z400 DR-Z400E Frame # __ __ __ __ __ __ __ __ __
RM125 RM250 DR-Z400 DR-Z400E Frame # __ __ __ __ __ __ __ __ __ RM125 RM250 DR-Z400 DR-Z400E Frame # __ __ __ __ __ __ __ __ __
RM125 RM250 DR-Z400 DR-Z400E Frame # __ __ __ __ __ __ __ __ __ RM125 RM250 DR-Z400 DR-Z400E Frame # __ __ __ __ __ __ __ __ __
Please send a new release when you buy additional RM or DR-Z models.
RACING INFORMAT I O N
Your Suzuki Dealer______________________________________City_________________________ State ________
Racing Classification(s) ____________________________________________________________________________
Race Organization(s)_________________________________________________ Racing #_____________________
SPONSORED RIDER AFFIDAV I T
(If the motorcycle is owned by another individual, the "sponsor" must complete the spon-
sored rider affidavit.) I have agreed to sponsor the rider listed on this form. I am the re g i s t e red owner of
the vehicle and understand that no additional person(s) other than indicated will be paid contingency fro m
American Suzuki Motor Corporation.
Ow ner's Nam e________________________
A d d ress ______________________________________City______________________State________ Zip __________
Owner's Signature___________________________ Date ________
I HAVE READ AND UNDERSTAND THE FOREGOING RELEASE.
S i g n a t u re of Racer_________________________________________________________________ Date___________
S i g n a t u re of Guardian (if racer is under 21 years)____________________________________ Date___________
AMERICAN SUZUKI
P.O. BOX 1100
BREA, CA 92822-1100
ATTN: M/C CONTINGENCY
SEND ONLY ONE FORM FOR THE CALENDAR YEAR. Remit to:
ALL RM AND DR-Z MOTORCYCLES MUST BE REGISTERED THROUGH AMERI CAN SUZUKI MOTOR CORPORATION FOR
CONTINGENCY PAYMENT. TWO OR MORE RACERS CANNOT SHARE ONE MOT ORCYCLE, IN OTHER WORDS, ONLY ONE
RACER CAN REGISTER IN THE PROGRAM, QUALIFY FOR PAYMENT, AND RECEIVE PAYMENT PER MOTORCYCLE VIN#. IF
THE MOTORCYCLE WAS A SECOND PARTY PURCHASE, PLEASE PROVIDE A COPY OF THE NEW OWNER REGISTRATION.
