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ACT 2012 Roll Chart Order FORM
By check only

Name:

Address:

City:

State:

Zip:

Phone:

E-mail:

Partner:

T-shirt Size:

Membership

Blue Mountain Ride-June 2/3

Railtime Ride   June 30/July 1

Big Sky Ride   July 28/29

Donner Ride   August 25/26

Fall Ride   Oct 13/14

Gold Country Ride  Oct 27/28

The minimum for mail order is for 2 riders which is already figured into the costPremier Members are half price     

Mail Order

Mail this completed entry to    ACT: P.O. Box 1474, San Andreas, Ca. 95249 

Personal Assumption of Risk and Waiver of Liability:  I know that when I participate in an ACT Ride or follow an ACT roll-chart I will encounter serious dangers and unsafe conditions without any warning and I could suffer serious injury or death.  I know that ACT nor anyone else provides any safeguards or any precautions to protect me from dangers or injury. Motorcycle riding is a dangerous activity. Knowing all this, I still want to participate and voluntarily take full responsibility for my own safety and for all liability, injury, harm, or any problems that may happen to me as a result of participating in an ACT ride or following an ACT map.  I choose to do so without knowing to what extent any of that might be.  I promise to never make any claims whatsoever for any personal damages, injury, or losses associated with any ACT ride, roll-chart, or map regardless of the circumstances.  I know ACT offers no medical or liability insurance coverage for me.  I have read and understand this statement and certify my agreement by my entry.

                                                                        EMAIL: actrides@goldrush.com