pro motion logo 2005 Pro Racing (R) ISA/GSRA
Rocky Mountain Scootercross® Tour

OFFICIAL ENTRY FORM
PMRP 
P.O. Box 1201
Loveland, CO 80539-1201
Business Office:  303.333.2011Fax:  (970)622-0668
 Event Operations:   (720)771-2011 
 
PLEASE COMPLETE ALL INFORMATION!
This Entry for Event
Last Name 
First Name 

Street
City  State  Zip 
New address? yes no     1st Time Entry with PMRP? yes no 
Phone 
Fax 
E-mail 

Birthdate   Age SSN 
ISA/GSRA Member #   Card Exp.   Race # 
Emergency Contact 
Emergency Phone 

Health Ins Co 
Health Ins Policy # 

Primary Doctor 
Primary Doctor Phone 

Is your Go-Ped® being raced by any other racer? yes no 
By
who  
What class(es) 

Sponsors (4 Max.) 

Note: To qualify for pre-entry discount your entry form, full payment must be received by the Wednesday prior to the event. Waiver must be signed at check in before practice.

 
Series Events Closed Course Class Legend
Mailed - Faxed - On-Line Pre-Entry $5 Push Ped / $20 Jr and Beg / $30 Nov and Exp / $30 Vet / $30 Wmn / $40 Pro / $25 IROC Pro (RDA)**
AM All
Race Day Entry $10 Push Ped / $30 Jr and Beg / $40 Nov and Exp / $40 Vet / $40 Wmn / $50 Pro / $35 IROC
Jr 13yr -
Vet 35yr +

** Race Director Approval

All pre-entries must be received by Thursday prior to race day.

Select the events you want to enter below.
Enter Ped Number in boxes at right  Example: 303

"+" Denotes ISA Natl and WF Classes Classes Between Dotted lines = Overall Regional Points Classes
Registration #01
Registration #02
Registration #03
Registration #04
Registration #05
Registration #06
Registration #07
Registration #08
Registration #09
Registration #10


Payment by Credit Card (Mailed,Faxed or via this form) or Check (Mail Only)

MC  Visa
Account # 
Expiration Date:
    Total Amount $ .00


Note: Original signature required on race day.