3
2005 RM & OFF-ROAD CONTINGENCY RIDER
REGISTRATION FORM
November 1
st
, 2004 to October 31
st
, 2005
Note: Please Print Clearly to ensure information is legible.
Name ___________________________________________________________
Address _________________________________________________________
City__________________________________ Province___________________
Postal Code ________ Phone # ________________________
E-Mail Address_________________________________________
Sanctioning Body: CMA ______ MMA______ CMRC______ CMX _____
License number: ________________ Competition number: ______________
Rider's Competition Classification: __________________________________
(ex. Expert, Amateur, Novice, Schoolboy, Veteran, etc)
Suzuki Motorcycle(s) being raced:
Model
Serial Number
________________________
________________________________
________________________
________________________________
Rider's Signature:
Date:
M/D/Y
Signature of Parent or
Guardian if under 18
Date:
M/D/Y
Registrations must be received at Suzuki Canada Inc. prior to May 31, 2005. Registration
forms received after May 31, 2005 will be eligible for contingency from the date they are
received. There will be no "retro-active" payments on registrations received after May 31,
2005. It is your responsibility to ensure that Suzuki Canada Inc. has received your
registration form. Registered mail is the best form of ensured delivery.
Motorcycles must be 2003, 2004 or 2005 Canadian models, purchased in Canada to
qualify for contingency.
Fax or mail this registration form to: RM & Off Road Race Contingency, Suzuki Canada Inc., 100
East Beaver Creek Road, Richmond Hill, Ontario L4B 1J6 Fax (905) 764 1574.
Allow time for result verification & mailing (8 wks approximately). Payment will be made based on official published
results only. Suzuki cannot be responsible for any delays in receipt of such information from the sanctioning groups.
