Shasta SuperMoto Membership ApplicationOne membership application per personPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone *Emergency Contact Information *FirstLastPhoneEmail *Membership type *Operational Support Membership – $0.00Youth Rider Membership – $50.00Working Membership – $100.00Non Working Membership – $300.00Parent/ Guardian Information *FirstLastPhone *Parent/Guardian Membership Type: *— Select Choice —Working MembershipNon-Working MembershipOperational Support MembershipMEMBERSHIP TERMS AND CONDITIONS • Memberships are valid for 12 months from the date of signup unless suspended or terminated by the club. • Membership fees are non-refundable. • Members are responsible for renewing their membership upon expiration. • Members must follow all club, facility, safety, and track rules. • Shasta SuperMoto reserves the right to suspend or terminate memberships for rule violations, unsafe conduct, or behavior determined to be detrimental to the club, facility, or participants. • Membership termination may occur without refund. Membership Terms Acknowledgment *I certify that I have read, understand, and agree to the Membership Terms and Conditions listed above.Parent/Guardian Authority Certification *I certify that I am the parent or legal guardian of the minor applicant and have legal authority to sign this registration, waiver, and all related documents on the minor’s behalf. 📄 Read Waiver Electronic Waiver Signature * Clear Signature WAIVER SIGNATURE By signing above, I certify that I have read, understand, and agree to the Shasta SuperMoto Release and Waiver of Liability, Assumption of Risk, Medical Authorization, Media Release and Indemnity Agreement. I understand that my electronic signature has the same legal force and effect as my handwritten signature. Signature Date Stripe Parent/Guardian Electronic Waiver Signature * Clear Signature PARENT / LEGAL GUARDIAN WAIVER SIGNATURE By signing above, I certify that I am the parent or legal guardian of the minor applicant, have authority to sign on the minor’s behalf, and agree to the Shasta SuperMoto Release and Waiver of Liability, Assumption of Risk, Medical Authorization, Media Release and Indemnity Agreement. I understand that my electronic signature has the same legal force and effect as my handwritten signature.Electronic Signature Consent *I consent to the use of my electronic signature and understand that it has the same legal force and effect as an original handwritten signature.Total$0.00Stripe Credit Card *Submit