Fire an Iron MC Station 17
2011 Ride for the Burn Camp
Registration Information


Rider Name: ____________________________________________________________________________

Address: _______________________________________________________________________________

   ______________________________________________________________________________

Phone: (             ) ______________________________________________________

Rider Cost: $15.00


Passenger Name: _______________________________________________________________________

Address: ______________________________________________________________________________

______________________________________________________________________________

Phone: (             ) _______________________________________________________

Passenger Cost: $10.00

WAIVER OF LIABILITY
(Please Read)

I the undersigned understand that Fire and Iron MC and any sponsors, donators, organizers, and volunteers of the 2011 Ride for the Burn Camp held on Saturday July 9^th, 2011, cannot and will not assume or be held for any responsibility for any aspect of my safety on this ride. I am participating in this ride voluntarily on my own assessment of my skills and abilities. By signing below, I assume all risk and release and hold harmless Fire and Iron MC and any sponsors, organizers, donators, or volunteers of the 2011 Ride for the Burn Camp for any injury or loss, including death, to my person or property in which I may become involved in by reason of participating in this ride. I understand that this is a self-guided ride and that I have to abide by the state laws and rules of the road. Any unsafe or dangerous acts or riding may result in being ejected from the event. I also understand that this ride requires me to stop at businesses that serve alcohol and that I am 21 or older and of legal drinking age in the state of Wisconsin.

Riders Signature:                                                                      Passengers Signature:

______________________________________                       ________________________________         
         
                             Today’s Date:                                                                        Today’s Date:

                 _______/_______/_______                                                      _______/________/________

Make Check or money order out to: Fire and Iron MC Station 17

Fill out form and mail along with fee  to: Fire and Iron  MC St. 17
                                                                   3620 S. Cottonwood Rd
                                                                   New Berlin, WI 53151