Winchester Speedpark 2012 Membership Form
Membership fee $75 for 2012 - Family Discount – 1-3 Members pay – 4+ free – Must be child or spouse
Fields Marked by * Are Required
*First Name: *Last Name:
*Address: *City:
*State: *Zip Code:
*Phone: *DOB:
*Age: *Email:
Emergency Contact and Phone (if Different):
Choose 3 RACE #’s NO X’s allowed (Used for One Day Members) renew wsp # by 1/14
*Race # *Race # Choice 2:
*Race # Choice 3    
*Racer’s Experience please circle one:
Beginner - Novice- Amateur - Expert/Pro
*Bike 1 Size: *Bike 1 Brand:
Bike 2 Size: Bike 2 Brand:
***For contingency choose bike brand and be sure to check results on race day for proper listing***
*You (rider) must race in proper class (Novice Amateur or Expert) and must compete in the highest classification you have held or hold in any organization or events past or present. Select all classes you will be competing in for 2012
50 4-6 50 7-8 50 Open 4-9 65 C 7-11 65 B 7-11
65 A 7-11 65 Open 12 and Under 85 C 7-15 85 B 7-15 85 A 7-15
Supermini 7-16 Youth C 18 & Under Youth A & B 18 & Under 250 C (Lites) 250 B (Lites)
250 A (Lites) 450 C (Mx) 450 B (Mx) 450 A (Mx) Open C
Open B Open A 30 C 30 B 30 A
40 C 40 B 40 A MUST CHOOSE ONE: Girls Women

ALL STEPS MUST BE COMPLETED

  1. Complete this form with a signed, NOTARIZED waiver (other side)
  2. If you are Under 18 also submit a Minor release form (print off site or complete at track) NOTARIZE on BOTH sides
  3. Copy of Birth Certificate for age defined classes IF we do not have on file
  4. Membership fee - $75 for 2012 WSP Race series ($60 before 12/31/11)

You must have a Transponder to participate - purchase at track or $10 Day Rental with deposit
After 4/1/12 – Forms/Memberships accepted at track only – not by mail

Winchester Speedpark Release Form
WSP 512 & 517 Keene Rd Winchester, NH 03470
Southwick MX338 46 Powder Mill Rd Southwick, MA
FOR ENTIRE 2012 Season
Motocross Track – Supercross Track – Fieldtrip Mx Tracks

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT IN CONSIDERATION of being permitted to participate in any way in the sport and activities of Motocross/Supercross under the auspices of Winchester Speedpark LLC and WSP Holdings LLC or any WSP Series event, I acknowledge, appreciate, and agree that:

1 . The risk of injury from the activity and equipment involved in motorized off road activities is significant including the potential for permanent disability and death, and while particular protective equipment and personal discipline will minimize this risk, the risk of serious injury does exist;

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown EVEN IF ARISING FROM THE NEGLIGENCE of those persons released from liability below, AND ASSUME ALL RESPONSIBILITY FOR MY PARTICIPATION; and,

3. I understand that the activities of motorized off road activities are physically and mentally intense. I understand the rules of play and will comply with all rules and regulations. If I observe any unusual or unnecessary hazards during my participation, I will bring such to the attention of the nearest official as soon as practical AND LEAVE THE AREA;

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, FOREVER RELEASE AND HOLD HARMLESS WINCHESTER SPEEDPARK LLC, WSP HOLDINGS LLC, MX338, THE OWNERS AND LESSORS OF THE PREMISES USED TO CONDUCT THE MOTORIZED OFF ROAD ACTIVITIES, THEIR OFFICERS, OFFICIALS, AGENTS, PROMOTERS, SPONSORS AND/OR EMPLOYEES ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

5. I understand and agree that the release of Liability AGREEMENT covers each and every motorized off road activity and/or event in which I participate or attend hereafter.

6. I UNDERSTAND THAT THE PROMOTERS OF WINCHESTER SPEEDPARK LLC, WSP HOLDINGS LLC OR MX338, DO NOT PROVIDE HEALTH INSURANCE. THE UNDERSIGNED FURTHER AGREES TO ASSUME ALL RESPONSIBILITY FOR DOCTOR, AMUBULANCE, HOSPITAL AND MEDICAL EXPENSES AND ANY LOSS OR INJURY TO ME/THE MINOR AND/OR PERSONAL PROPERTY DUE TO PARTICIPATION IN ANY WINCHESTER SPEEDPARK SERIES EVENT.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements or inducements apart from the forgoing written agreement have been made.

* I HAVE READ THIS RELEASE I have and will maintain health insurance to race and or practice at WSP events and I have Read the Rules for WSP and agree to comply

 
 
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