DEATH VALLEY "D-V" RUN XVI OCTOBER 6 – 8, 2003

PRESENTED BY MAX BUBECK AND CO-SPONSORED BY THE SOCAL CHAPTER A.M.C.A

PLEASE RETURN THIS FORM, COMPLETED BY SEPT. 6, 2003 WITH YOUR CHECK PAYABLE TO: SoCal AMCA

PRINT NAME:_________________________________________AMCA # :________________

ADDRESS:____________________________________

PHONE:___________________________________

CITY:_________________________________________________

STATE:___________ZIP:_____________________

CLUB:____________________________MAKE / MODEL / YEAR OF ENTRY:_______________________

INSURANCE CARRIER & POLICY #________________________________________

REGISTRATION FEE FOR EACH MACHINE includes T-shirt, Trophy & Barbeque. $ 85.00

Please indicate T-shirt size: S___________M__________L_____________XL___________XXL__________

Extra T-shirts: (Quantity)___________X $10.00 $_____________

Extra Barbeque Tickets: (Quantity)__________X $35.00 $_____________

TOTAL AMOUNT ENCLOSED:$_____________

Make Checks Payable to: SoCal AMCA

MAIL TO: TOM HART

6011 FAIRBROOK ST.

LONG BEACH, CA 90815 (562) 596-7630

Riders must be current members of The Antique Motorcycle Club of America. Motorcycles are limited to 1968 & earlier. California law requires helmets to be worn. Each person is responsible for his/her room, call (760) 786-2345 for reservations. All rooms have two double beds. Tell them you are with the antique motorcycle group. Deadline is September 6, 2003. Limited to 100 entries. RV & camping spaces are available, call the above number.

CALIFORNIA LAW REQUIRES PROOF OF LIABILITY INSURANCE ON YOUR CYCLE.

ALL PARTICIPANTS MUST READ AND COMPLY WITH THE FOLLOWING:

I understand & hereby agree to comply with the rules governing this event; & further agree to hold blameless, MAX BUBECK, The SoCal Chapter of the AMCA and any other person or person's for any loss or injury to myself or property in which I may become involved by any reason of participating in this event.

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ENTRANT'S SIGNATURE