Rider's First Name *
Last Name *
Date of Birth (00/00/00) *
Home Number *
Cell Number(s) *
Emergency Contact Name *
Emergency Contact Number *
Which Two Class(es) will you be racing at the 2013 Red Bull AMA Amateur National Motocross Championship? *
Due to helmet size limitations, the 51cc Classes are not elegible for this support program.
Helmet Size *
Apparel Size (T-Shirts) *
Only XS, S, M, L, XL & XXL are available
Youth S, M Adult S, M, L, X, XL & XXL
IMPORTANT INFORMATION YOU MUST KNOW
You MUST be racing the 2013 Red Bull AMA Amateur National Motocross Championship to particpate in this program.
Rider selection is based solely on the discretion of
- Not every applicant will be accepted.
Rider must wear the official
Bell Helmet to qualify for contigency payment.
Rider will purchase the helmet at the discounted rate of $200 plus shipping (This helmet is a $500+ value)
These are Bell Moto 9 Helmets, make sure you order the correct size as there are no returns.
Availability of helmets are limited to inventory in stock. Additional stickers can not cover the Bell or Superstore logos.
Accepted riders will be contacted by phone and payment will be collected through Visa or MasterCard or Check.
Contingency will be paid in the form of
Gift Certificates with the following payout schedule:
1st Place in Class $500; 2nd $400, 3rd $300, 4th $250, 5th $200, 6th $150, 7th $100, 8th $100, 9th $50 & 10th $50.
Deadline to recieve Applications is July 15, 2013. Riders will be notified by July 9. Helmets begin shipping July 10.
I have read, understand and agree to the above information.
Type in YES *
Date 00/00/00 *
Parent or Guardian Name(s)
You must provide Parent or Legal Guardian information if the rider is under 18 years of age.
If you need to mail a check please send to: Tim Clark, Motorcycle Superstore, 1555 E. McAndrews, Medford OR 97504