Ride Date: April 30, 2011

2011 ENTRY FORM - Limited to 35 scored riders. Please register early to secure your slot!! Advance registration may be to your advantage (hint, hint!!)
Contact Info:
Name: __________________________________________					Phone: (___ ) ___________
Address: ________________________________________					Cell:  (___ ) ___________
City: _________________		Zip: ___________			Email: _________________
Emergency Contact: _______________________________					Phone: (___ ) ___________
Equipment Info:
Bike Make: _____________		Model: ______________			Year: ___________
Bike Range: ________miles		Bike Color: __________
Entry Fee / Donation
[   ] I intend to ride		[   ] I can't ride, but here's my donation to the PKD Foundation
[   ] $50	[   ] $75	[   ] $100		[   ] Other	$ ___________
[   ] I plan on bringing more mouths to feed _______  (families are welcome at finish, dinner, awards... but we need a count!)
[   ] I am just coming in to eat (RTE)			[   ] My RTE will be the end of a BBG (or similar) and I need an IBA witness.
Submit Entry Form along with your fully deductible donation (check payable to PKD Foundation) to:
			San Diego BMW Motorcycles  5673 Kearny Villa Road San Diego, CA 92123
Please read and sign below: It is my responsibility to be properly licensed, insured and capable of safely operating my street legal vehicle. Regardless of any rally instructions I receive or interpret, I shall in no way deviate from following a safe course or speed. I will abide by lawful traffic regulations at all times. I will use my own best judgment and be prepared to alter route plans if unsafe conditions are encountered.
Signed: __________________________________________					Date: ______________