Amount remitted $_____________ Skill Level/Experience ___________

PLEASE MAKE CHECKS PAYABLE TO: Debbie Matthews-

26001 Corriente Ln. Mission Viejo, CA 92691

Gate fees extra.  Must sign a release form and pay fees prior to start of school. Rider and crew participates at own risk.  Rider has the option at anytime to withdraw from school for any reason.  Rider acknowledges the WSMX is not obligated to provide refunds.  Rider agrees to hold harmless school, agents, instructor or track and personnel and covenants not to sue.  Rider agrees to abide all rules and follow instructions given.

Rider Signature __________________________________ Date ____________

Parent/Guardian Signature _______________________ Date_____________

Drivers License Number of Consenting Parent or Guardian______________

Notary Signature (required if parent of child under 18 not present) 

Signature: ______________                       Date ___________ SEAL

Name ____________________________________________________  

Address __________________________________________________

City __________________________    State ____    Zip __________

Phone # ___________________________    Age of student _______

Fax ______________________  Email _________________________

School date requested _________________  Location __________ 

Type (please circle one)    Private    Group    

Location (please circle one)  California   Illinios   Texas   Washington  Colorado   Nevada   Other-_________________

ber or Returning Student Discount applied? Y  N  Amt: $25.00

Rental Equipment Needed-$75 Rental fee per day-(please input sizes needed for desired items)    

Pant ____ Jersey____ Gloves____   Helmet_____   Goggles-OTG or Std _______     Motorcycle Size ________        Height ______ Weight _______

Type of School desired (please circle one) 

Motocross     Desert       Cross Country       Off Road       Learn to Ride

Amount remitted $_____________ Skill Level/Experience ___________

PLEASE MAKE CHECKS PAYABLE TO Debbie Matthews:         

26001 Corriente Ln., Mission Viejo, CA 92691

Gate fees extra.  Must sign a release form and pay fees prior to start of school. Rider and crew participates at own risk.  Rider has the option at anytime to withdraw from school for any reason.  Rider acknowledges the WSMX is not obligated to provide refunds.  Rider agrees to hold harmless school, agents, instructor or track and personnel and covenants not to sue.  Rider agrees to abide all rules and follow instructions given.

Rider Signature ____________________________ Date ______________

Parent/Guardian Signature ___________________ Date_____________

Drivers License Number of Consenting Parent or Guardian__________

Notary Signature if under 18 _________________  Date _____________

Name ____________________________________________________  

Address __________________________________________________

City __________________________    State ____    Zip __________

Phone # ___________________________    Age of student _______

Fax ______________________  Email _________________________

Skill Level/Experience _____________________________________

In Case of Emergency notify: ________________________________ 

Location (Please Circle) AL  SO.CA  NO.CA  CO  TX  UT  WA  NC  PA

OTHER  _{_____________}

Family Member or Returning Student Discount applied? Y  N  Amt: $25.00 per day

Training Camp Cost: $ 600.00

I will pay for the camp: 

_______ I have enclosed the total payment of  $600.00 for the camp 

_______ In Three installments of $ 200 each.  

_______ Other Arrangements (Pre-Approved By WSMX)

With this deposit _____ ($100 min), please reserve a space for me at the camp.  I promise to pay the balance due before start of camp or my deposit and reservation is forfeited.  No exceptions

Note: If I am unable to attend the camp, and with the determination of each individual case made by the WSMX, CEO, I understand that up to $ 500.00 of my registration may be returned.  I also understand that WSMX will retain $100.00 of the total amount required for the camp to cover cancellation costs, and will not be returned.

Signature of Applicant______________________________________

Amount Paid _____ Balance Due ____ Discount Applied  $ ______ Initials ____  Date Recv_____

The price of the Training camp is $ 600.00, which includes Training by WSMX Staff, All seminar classes for 3 DAYS. 

Special Arrangements:

____ I wish to attend ONE DAY ONLY     Date I will Attend ___________

____ I wish to attend TWO DAYS ONLY  Dates I will Attend __________

____ I wish to stay at the track (payable at the track)

____ Please pick me up at Airport: $15.00 fee each way.  ($30.00 Total)

Airport ______________  Airline ______________  From: _______________

Incoming Flight #  __________  Time _____ Day _____

Returning Flight: Time _____________ Day __________

_____ I Will Need Rental Equipment -$75 Rental fee per day

(please input sizes needed for desired items)    

Pant ____ Jersey____ Gloves____   Helmet_____   Goggles-OTG or Std _______     Motorcycle ________       Height ______ Weight _______

Total Extra Charges: _______    (Rental Equipment)

Amount Paid (1)________ (2) ________ (3) _________ (4) __________

PLEASE MAKE CHECKS PAYABLE TO Debbie Matthews-26001 Corriente Ln., Mission Viejo, CA 92691

Gate fees extra.  Must sign a release form and pay fees prior to start of school. Rider and crew participates at own risk.  Rider has the option at anytime to withdraw from school for any reason.  Rider acknowledges the WSMX is not obligated to provide refunds.  Rider agrees to hold harmless school, agents, instructor or track and personnel and covenants not to sue.  Rider agrees to abide all rules and follow instructions given.

Rider Signature ____________________________ Date ______________

Parent/Guardian Signature ___________________ Date_____________

Drivers License Number of Consenting Parent or Guardian__________

Notary Signature if under 18 _________________  Date _____________