San Quintin Training with RALLY COMP:              May 19-21, 2023                                       
*UTV DRIVERS, CO-DRIVERS AND MOTORBIKE RIDERS MUST COMPLETE THEIR OWN FORM
*MANAGERS, FRIENDS, FAMILY OR SPOUSES MAY NOT COMPLETE AN APPLICATION FOR ANY ENTRANT
*YOU SHOULD READ AND UNDERSTAND EVERY PROVISION BELOW
*YOU MAY NOT PLEAD IGNORANCE OF ANY PROVISION THEREAFTER



1) This form is not valid without a deposit at the time of application and will be discarded within 24 hours.
2) Rider/ Driver forfeits any priority or benefits associated with priority if this form is submitted without payment. Conversely, any payment or deposit received without an accompanying application will be flagged, timestamped and held for 24 hours as a courtesy. An email will be sent to the email address associated with the payment. If your application is not received for that payment or deposit, BAJA RALLY will consider 100% of the payment or deposit as a non-refundable gift. If you choose to submit your application after giving BAJA RALLY a free gift, we will give you a break and only charge you a $500 penalty to re-instate your previously botched entry.        
3) Riders/ Drivers must be truthful and accurate in their responses.
4) Any material misrepresentation(s) on this application will be grounds for disqualification from the BAJA RALLY and forfeiture of any and all deposit or payments to BAJA RALLY LLC.
5) Applicants may not apply to enter any other BAJA RALLY events without prior roadbook navigation experience. Completing this "Training Event" qualifies riders for such events. 
6) The organizer may exclude any applicant it believes is not qualified to participate, or for any other reason.
7) Applicants must provide their individual or group plan health insurance information or attest they are uninsured at time of application and must be re-confirmed before the event.
8) BAJA RALLY, LLC WILL NOT SHARE YOUR INFORMATION WITH ANYONE EXCEPT AS NEEDED BY MEDICAL
    PROFESSIONALS IN THE EVENT OF AN EMERGENCY DURING THE BAJA RALLY.
9) Your application is not considered accepted until the applicant has received an email confirmation from admin@bajarallymoto.com
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BAJA RALLY SCHOOL Training Event May 19-21, 2023
PERSONAL INFORMATION
This is required information about you and will not be released or shared with anyone other than your named emergency contact and/or medical personnel in the event of an emergency. By submitting this form you are consenting to BAJA RALLY sharing this information in such a manner, for your benefit.
First Name *
As will appear on the trainees' list
Last Name *
As will appear on the trainees' list
Street Address *
PO Box is NOT acceptable
City *
State *
Zip Code *
Country *
Phone Number *
Include country and regional dialing codes
Email address *
Emergency Contact Name *
Emergency Contact Phone *
Full Legal Name *
As appears on your Passport or government ID
Date of Birth *
MM
/
DD
/
YYYY
Who Referred You To BAJA RALLY Training?
UTV DRIVER/ CO-DRIVER NAME
If you are a UTV driver list your teammate / UTV Co-Driver Name below. If you are a UTV co-driver, list your teammate / UTV Driver name below. If you are a applying for a Motorcycle classification write "MOTO" in the space below
Existing Medical Conditions *
List All or type: NONE here
Blood Type
Clear selection
Allergies *
List All (type "NONE" if there are none known)
What is your level of expertise in off-road motorcycle / UTV riding/ driving? *
Have you participated in a "road book-navigation" style rally or similar "road book training"? *
What is your level of roadbook navigation experience *
MOTORCYCLE / UTV
Year, Make, Model & Type
Year *
Make *
Model *
Type *
Does your motorcycle /vehicle have an electronically powered road book reader? *
Does your motorcycle / vehicle have an electronically powered, adjustable odometer? *
What is the approximate range (miles) of your motorcycle or vehicle on a full tank of gas *
Riders & drivers will need a minimum of 80 miles of minimum range to participate in the ARO Rally Training
Social Media
Add your FB, IG and other social media links and/ or tags so our media team can link to you
RELEASE, WAIVER & INDEMNIFICATION
Please be advised that by submitting this form and/or making any payment to BAJA RALLY de Mexico and/or BAJA RALLY LLC, you are acknowledging that motorcycle & UTV riding and racing is inherently dangerous and participating in an off-road rally is especially hazardous and potentially perilous. Prior to participating in the BAJA RALLY, you hereby release Darren Scott Bloom, BAJA RALLY de Mexico, BAJA RALLY LLC, its principals, organizers, staff, volunteers, partners and sponsors from any liability whatsoever, financial or otherwise, if you are injured or killed during, or as a result of, your participation, in the BAJA RALLY. You acknowledge that you will further be subject to reading, understanding and signing multiple additional waivers and releases of liabilities which further indemnify Darren Scott Bloom, BAJA RALLY de Mexico, BAJA RALLY LLC, its principals, organizers, staff, volunteers, partners and sponsors from any and all liability if you sustain property damage or are injured or killed during, or as a result of, your participation in the BAJA RALLY, whether it is caused by an accident or by the gross negligence of Darren Scott Bloom, BAJA RALLY de Mexico, BAJA RALLY LLC, its principals, organizers, staff, volunteers, partners and sponsors.

I hereby give up all my rights to sue or make a claim for damages due to negligence or any other reason whatsoever against BAJA RALLY LLC, Darren Scott Bloom, their staffs, affiliates, members, promoters, sponsors and all other persons, participants or organizations conducting or connected with this event for injury to property or person that I may suffer, including crippling injury or death, while participating in the event and while upon the event premises.

I know the risks of danger to myself and my property while preparing for and participating in the event and while upon the event premises and, relying on my own judgment, skill and ability, I assume all such risks of loss and hereby agree to reimburse all costs to those persons or organizations connected with this event for damages incurred as a result of my negligence.  

I understand that there is no insurance to claim against if I am injured or killed in this event. I understand that any insurance for BAJA RALLY LLC, Darren Scott Bloom, their staffs, affiliates, members, promoters, sponsors and all other persons, participants or organizations conducting or connected with this event, provides coverage if a spectator or property owner makes a claim against BAJA RALLY LLC, Darren Scott Bloom and/or our affiliates. I understand that the policy clearly excludes any and all liability claims that could conceivably by made by people like me who are actually participating in this event.

 
Your application to participate in the BAJA RALLY can be denied for any reason. A full refund of your registration fee of deposit will be returned to the applicant if the application is declined during this 30 day period.
Have you read and do you understand the RELEASE, WAIVER & INDEMNIFICATION statement above? *
PAYMENT REQUIRED *
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