Lehigh Valley ATV Association Inc.

June 9, 2012

This is a Guided ATV Ride that will benefit the Relay for Life Team of the American Cancer Society from Bucktail Medical Center in Renovo, PA. The Ride will start from Renovo (in relays), proceed to the Parking Lot of the Bloody Skillet ATV Trail located on DeHaas Road and then return to Renovo. It will be a total of approximately 50 miles. If your ATV cannot handle this many miles, you should carry extra gasoline with you. Once your relay is underway, you will be required to stay with the relay for the entire ride. All operators must stay on route and follow all signs. Any ATV operating on the trail and not properly guided will be subject to fines and/or removal from the event. A maximum of two hundred fifty (250) ATV machines will be accepted.

                                                                      REGISTRATION

(Operators or passengers must complete a Registration Form and a Release of Liability Form before they receive full registration)

Operator or Passenger Name____________________________________________________________________

Address_____________________________________________________________________________________

City____________________________________________ State_____________ Zip________________________

Cell Phone:______________________Home Phone:__________________ Email:__________________________

I will be: (check only one):

___________ Operator          Regular $35 - Early $30.00 (Post Marked by May 26) – 12 – 15 yrs old with certification

___________ Passenger         Regular $15 - Early $10.00 (Post Marked by May 26) – Age limit 8 yrs old

My signature below indicates that I understand and will abide by Pennsylvania’s All-Terrain Vehicle Law and the event rules and regulations.

Signature:   ____________________________________               Date: _________________________________

******************************************************************************************

YOU WILL BE REQUIRED TO HAVE THE FOLLOWING DOCUMENTS WHEN YOU CHECK IN: (1) CURRENT ATV REGISTRATION,(2) CURRENT ATV PROOF OF INSURANCE AND (3) PROOF OF AGE. WITHOUT THESE REQUIRED ITEMS YOU WILL NOT BE ALLOWED TO PARTICIPATE.

Information you provide will be kept confidential and used only for purposes of the event. 

Pennsylvania ATV Registration Number: _________________________ Exp. Date:________________________

ATV Insurance Company Name:__________________________________________________________________

ATV Ins. Policy#:________________________________ Policy expiration date:___________________________

Please return this form and fees (check made payable to: BMC Relay for Life) to:                                                                                    BMC Relay for Life – ATV Registration, 1001 Pine Street, Renovo PA 17764

Event Rules, FAQ’s, and additional information can be found at: www.renovoatv.eventbrite.com