2012 Membership Application and Renewal

Over The Hill Gang, Bay Chapter

You MUST be age 30 or older to join if male, age 25 or older to join if female. There is no grace period for the age requirement. Dues are $35.00 to join and then $35.00 per calendar year there after.

Personal Information Section:

Name: First

Last

Email Address

Referred By

Address

City

State

Zip Code

Phone

Phone 2

Birth Date(MM/DD/YYYY)

Age

Occupation

I prefer to receive the OTHG updates by

Riding History: (For new Members Only)

I have been riding motorcycles in some form for years.

I have been racing for years. My last race was in date (MM/DD/YY)

I have attained the Highest classification of:

In the following race format: MX Off Road Dirt Track
Other

I have raced at least once in each of the following :

Motocross	Flat Track	Speedway
Road Racing	Off Road/WORCS	Enduro
Trials	Desert	Vintage/AHRMA

All New Members must check in with our Race Director at your next 2 events for evaluation and proper Class assignment.

I am or Have been a Member of OTHG before

2010 Race Numbers:

If you earned a top 25 number in the 2010 season you are entitled to run that number in the 2011 season. Otherwise you may keep your current (non-top 25) number or select any available number (26 – 999). Your non-top 25 2010 number will be reserved for you until the membership renewal deadline of Jan 31, 2011. After that date, all remaining numbers will be considered available.

I earned a top 25 number and wish to reserve my non-top 25 2010 race number as my permanent number.

I will keep and run my 2010 non-top 25 number

I will select a new non-top 25 number as noted below.

1st Choice 2nd Choice 3rd Choice

Certification and Agreement

Under the articles and bylaws of the Over The Hill Gang Association, I hereby agree to conform to and to comply with all rules governing all competitive events while participating as a member of the Over The Hill Gang Association. I further agree to hold blameless the officers and members of the Over The Hill Gang Association, and property owners for any loss or injury to myself, my property, or any family member accompanying me to a competitive event. I do also agree to assume responsibility for any property damage which I knowingly initiate. I fully understand motorcycle riding and racing is dangerous and can result in severe injury or even death. I have read the preceding paragraph and do agree with this statement and certify that all facts submitted are true and accurate.

I have read and agree to the above paragraph

Membership Type

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