Ride Date: April 28, 2012

2012 ENTRY FORM - Limited to 35 scored riders. Please register early to secure your slot!! Advance registration along with your email address may be to your advantage (hint, hint!!)
Contact Info:
Name: __________________________________________					Phone: ( ___ ) ___________
Address: ________________________________________					Cell:  ( ___ ) ___________
City: _________________		Zip: ___________			Email: _________________
Emergency Contact: _______________________________					Phone: ( ___ ) ___________
Equipment Info:
Bike Make: _____________		Model: ______________			Year: ___________
Bike Range: ________miles		Bike Color: __________
Entry Fee / Donation		[   ] Donation Only, I can't ride this year
[   ] I intend to ride the LowCal250		[   ] I want to compete in the arm-chair class
[   ] $50	[   ] $75	[   ] $100		[   ] Other __________	(any donation is welcome!)
[   ] I plan on bringing ______ more mouths to feed. (families are welcome at finish, dinner, awards... but we need a count!)
Submit Entry Form along with your fully deductible donation (check payable to PKD Foundation) to:
			San Diego BMW Motorcycles  5673 Kearny Villa Road San Diego, CA 92123
Please read and sign below: Motorcycles are an inherently risky mode of transportation, and I assume all associated risks and liabilities. It is my responsibility to be properly licensed, insured and capable of safely operating my street legal vehicle. Regardless of any rally instructions I receive or interpret, I shall in no way deviate from following a safe course or speed. I will abide by lawful traffic regulations at all times. I will use my own best judgment and be prepared to alter route plans if unsafe conditions are encountered.
Signed: __________________________________________					Date: ______________