The 2011 Land of Enchantment 1000
September 30-October 2, 2011
Registration Form and Release
Name(s): ____________________________________________ Class: 1-up ____ 2-up ____
Address: ____________________________________________
City: _____________________________ State: __________ Zip: _______________
Phone: (days) _____________________ (nites) ________________
email address: ____________________________________________________
Obtained an ID card: YES _______ NO ______
You can print such a card free at: http://www.medids.com/free-id.php
Shirt size: ____1-up Shirt size:_____2-up
Motorcycle Make and Model: __________________________
License Plate State: ________ Number: _______________
Any Prior IBA rides: ____________________________________________________
_____________________________________________________
_____________________________________________________
Room Reservations at: ____________________ or N/A _____
I would be willing to share a room: YES _____ NO _____
We are again setting up our rally headquarters at Western Skies Inn & Suites, Los Lunas, NM
their phone number is 505-865-0001
We have 25 room blocked please let them know you are part of the LOE 1000.
RELEASE:
I understand that the LOE/1000 is a motorcycle rally and that as such it includes activities which should only be undertakenby competent, experienced motorcyclists. I agree to abide by all applicable traffic regulations in the state(s) in which I rideand I accept full and complete responsibility for any of my actions during this rally including but not limited to those affectingmy own safety. I hereby waive any and all claims I may have against the LOE/1000 Rally, its organizers, agents andsponsors which may arise as a result of my participation. Additionally, I agree to defend, indemnify and hold harmless the LOE/1000 Rally, its organizers, agents and sponsors from any claims made against them by third parties as a result of my participation.
Signature: ___________________________________ Date: _________________________
Make Checks payable to:
David C. Porter
4707 Palmas Altas Dr SE
Rio Rancho, New Mexico 87124
Rally Fee: $110.00 (Single)
$160.00 (Two-Up)
Extra Banq. Tickets: $36.00 each Make sure to check the Refunds Policies Web Page for applicable discounts before sending in
your entry.
September 30-October 2, 2011
Registration Form and Release
Name(s): ____________________________________________ Class: 1-up ____ 2-up ____
Address: ____________________________________________
City: _____________________________ State: __________ Zip: _______________
Phone: (days) _____________________ (nites) ________________
email address: ____________________________________________________
Obtained an ID card: YES _______ NO ______
You can print such a card free at: http://www.medids.com/free-id.php
Shirt size: ____1-up Shirt size:_____2-up
Motorcycle Make and Model: __________________________
License Plate State: ________ Number: _______________
Any Prior IBA rides: ____________________________________________________
_____________________________________________________
_____________________________________________________
Room Reservations at: ____________________ or N/A _____
I would be willing to share a room: YES _____ NO _____
We are again setting up our rally headquarters at Western Skies Inn & Suites, Los Lunas, NM
their phone number is 505-865-0001
We have 25 room blocked please let them know you are part of the LOE 1000.
RELEASE:
I understand that the LOE/1000 is a motorcycle rally and that as such it includes activities which should only be undertakenby competent, experienced motorcyclists. I agree to abide by all applicable traffic regulations in the state(s) in which I rideand I accept full and complete responsibility for any of my actions during this rally including but not limited to those affectingmy own safety. I hereby waive any and all claims I may have against the LOE/1000 Rally, its organizers, agents andsponsors which may arise as a result of my participation. Additionally, I agree to defend, indemnify and hold harmless the LOE/1000 Rally, its organizers, agents and sponsors from any claims made against them by third parties as a result of my participation.
Signature: ___________________________________ Date: _________________________
Make Checks payable to:
David C. Porter
4707 Palmas Altas Dr SE
Rio Rancho, New Mexico 87124
Rally Fee: $110.00 (Single)
$160.00 (Two-Up)
Extra Banq. Tickets: $36.00 each Make sure to check the Refunds Policies Web Page for applicable discounts before sending in
your entry.