TrailRideWith.US
Sign-Up Form (LA to Barstow to Vegas) Thanksgiving 2012
up to 600cc $750 by Sept. 1 - $850 after Sept 1
over 600cc $850 by Sept 1 - $950 after Sept 1
First Name _____________________
Last Name _____________________
Street _____________________
City _____________________
Zip _______ Home Phone _________ Cell ___________
e-mail ____________
Emergency Contact Name ______________ #_____________
Bike _______________
Rider Skill Level: Newbee ( ) Used to be good ( ) Still pretty good ( )
Flat out impressive ( )
This trip only includes transportation of 1 bike, gear bag, and small suitcase
to Palmdale Ca. and pick-up of the same in Las Vegas.
Release form
I understand that I am participating on this ride of my own free will and hold myself fully responsible for any injury and or
damage I may suffer. No one else, either participants or persons involved with the organization of this ride, will be
responsible for my actions. I have made every attempt to prepare myself and my equipment for this ride and understand
that no one is more responsible for my safety and mechanical readiness than me.
X____________________________
Mail to check and this form to: Make check payable to Yvonne Aughinbaugh
ECS Honda, 878 E Main St, Ephrata Pa 17522 or 717-738-1184