AVDRA ~ National - Membership Form

The AVDRA is dedicated to the memory of American Moto Cross legend Jim Pomeroy.

"To old friends & old bikes."
Perris, CA October 2005

Annual Membership VMX, G.P.MX, and Hare Scrambles

Personal Information
First Name:		Last Name:
Date of Birth:	/ /	Age:
Address:		City:
State:		Zipcode:
Phone:		Emergency Phone:
E-Mail:		Confirm E-Mail:

Allergies & Medical Conditions

Racing Information
Racing #:

Vintage G.P. Modern Mini		Skill Level: Novice Intermediate Expert

*Payment Information*
Credit Card [$37.00] (Authorize.net Privacy Policy) Check, Cash, or Money Order [$35.00]


Refund Policy: A.V.D.R.A. does not refund membership payments.

Privacy Policy: None of the information that you enter here will be sold, traded, or given to any third party.

Security Policy: All the information you provide on this form will be e-mailed to A.V.D.R.A. for a printed backup version of your membership application. None of the information will be kept on A.V.D.R.A.'s server.

By applying for or renewing a membership in A.V.D.R.A., I agree to abide by all rules of A.V.D.R.A., as well as any event or track rules that may apply. I also accept that by submitting this form, my application will be treated as a signed document by me. A.V.D.R.A. retains the right to refuse service to anyone.
I have read and agree to the Refund Policy, the Privacy Policy, and the Security Policy.

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Contact Info: 480-464-7898 \| 1648 W. Bentley St. Mesa, AZ 85201