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LEM Application and Registration
Name
(Required)
Preferred Name Example Jim for James
(Required)
Email
(Required)
Cell Phone
(Required)
(Required)
Address
City
State / Province / Region
ZIP / Postal Code
AMA Number (if any) & expire date:
Shirt Size
(Required)
S
M
L
XL
XXL
XXXL
Emergency Contact name, relationship & cellphone
(Required)
Dakota 600
Consent, Release and Disclosure
By approving below, you agree to the following conditions while attending the Dakota 600.
Pictures-
You grant the Dakota 600 and Trail Stewards the right to use pictures of you for promotional materials, videos and slide shows.
Injury to yourself or equipment –
You hold harmless all parties related to the Dakota 600 and Trail Stewards.This release includes but is not limited to officers, directors, workers and volunteers.
Recording of tracks-
You agree not to electronically record the routes and tracks used for the Dakota 600. You agree not to communicate these routes and tracks to others not attending the Dakota 600.
Printed Name
(Required)
Signature
(Required)
Accommodation
(Required)
Are you traveling with family, fellow bike rider(s) or do you need special accommodation? Rooms are double occupancy so please add name of roommate(s) or if you would like a single room. Please make sure your desired roommate(s) put your name on their application as well.
Yes
No
Please describe below and add roommate(s) name
Please put date of early check in
MM slash DD slash YYYY
Will you be staying Thursday night July 17, or checking out early?
Answer
Event Checkout
Add for Single Room
No Room Needed
Add for Grand Prize
Product Name
(Required)
Bike #1 Information
Bike Make / Model
(Required)
Street Legal?
(Required)
Yes
No
State
Lic. Plate #
Head Light
(Required)
Yes
No
Tail Light
(Required)
Yes
No
Brake Light
(Required)
Yes
No
Horn
(Required)
Yes
No
Mirror
(Required)
Yes
No
Spark Arrestor
(Required)
Yes
No
Comments
Acknowledgment of Failure
I recognize that this bike does not meet minimum standards. I accept full responsibility for my own safety and the safety of my equipment. I release the Dakota 600, workers, riders, and Trail Stewards and their officers and directors from any liability that may arise from operating this motorcycle.
Signed
Date
MM slash DD slash YYYY
Bike #2 Information
Bike Make / Model
Street Legal?
Yes
No
Valid License Plate #
Yes
No
State
Lic. Plate #
Head Light
Yes
No
Tail Light
Yes
No
Brake Light
Yes
No
Horn
Yes
No
Mirror
Yes
No
Spark Arrestor
Yes
No
Comments
Acknowledgment of Failure:
I recognize that this bike does not meet minimum standards. I accept full responsibility for my own safety and the safety of my equipment. I release the Dakota 600, workers, riders, and Trail Stewards and their officers and directors from any liability that may arise from operating this motorcycle.
Signed
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
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LEM quantity
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