SIERRA
OLD TIMERS M.C. www.sierraoldtimermx.com
Age verified by (CA DL) ___________ Payment Received Check__________ Date___________ Cash ___________
SOTMX
C/O
George
Webb
P.O.
Box 1002
Petaluma,
CA 94953
The
purpose of this organization is to provide and encourage competition events for
the older motorcycle riders. To be eligible for membership the applicant must
have reached his/her 40th birthday. New members shall be considered
amateur class riders until classified by the club referee.
( ) Renewal $25 (over 65 $10)
( ) New member $25. Optional (encouraged) club jersey extra
Jersey Size: Med (
) Large ( ) X large ( ) XX Large ( ) XXX Large ( )
*All new members must provide proof of age, Birth
Certificate or DL*
All
dues are valid from January through December. Members are encouraged to renew early in order to get your
membership cards in a timely manner.
Please print clearly
Name: ____________________________ Birth date:
_____________
Address: _________________________ Phone (___)
_____________
Rider Classification Age Group:
40 ( ) 50 (
) 60 ( ) 70 ( ) 80 MSTR( )
MSTR A ( ) MSTR B ( ) 60 MSTR ( ) 50
MSTR ( ) EXP ( ) AMA (
) NOV ( )
I hereby apply for membership into the Sierra Old Timers
Motorcycle Club and swear to the above information to be true to the best of my
knowledge. I agree to maintain high standards of conduct conducive to the best
interests of the sport of motorcycling.
I, the undersigned, fully understand that motorcycling is
dangerous and at no time will I have legal or financial claim against, nor will
I hold responsible, any member or club officer of the Sierra Old Timers
Motorcycle Club or the International Old Timers Association for any damage or
injuries received by my participation in any Sierra Old Timers event, or any
International Old Timers Association event.
I WILL BE RESPONSIBLE FOR MY OWN ACTIONS AND THE ACTIONS OF MY GUESTS; I HAVE READ AND FULLY UNDERSTAND THIS RELEASE AND APPLICATION.