Membership Application – Lloydminster Motocross Association

Membership

Please complete application at one of our three locations for payment.

Membership Application

Adult, Parent or Guardian

Must be 19 years of age to complete this application.

This section is for consent, not rider information.

First Name

Last Name

Birth Date

Address

City

Province

Postal Code

Phone/Mobile

Emergency Contact

Emergency Contact Number

Consent, Release and Waiver of Liability

I have read, understand and agree to this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement.

Are any riders under the age of 19?

I have read, understand and agree to the Parental Consent, Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement.

Membership and Passes

Pass Type

Day Pass - $20

Family Day Pass - $40

Single Membership - $150

Family Membership - $250

How many in your Family?

Rider Information

Full Name

Birth Date

Age

Skill Level

Bike Make/Model

Second Rider

Full Name

Birth Date

Age

Skill Level

Bike Make/Model

Third Rider

Full Name

Birth Date

Age

Skill Level

Bike Make/Model

Fourth Rider

Full Name

Birth Date

Age

Skill Level

Bike Make/Model

Fifth Rider

Full Name

Birth Date

Age

Skill Level

Bike Make/Model

Extra Key - $5

I have read and agree to the Membership Guidelines.

Where are you purchasing your membership?