2024 Pumpkin Run ATV/UTV Rally

Personal Information

• * First Name:
• * Last Name:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• * Email Address:
• * Confirm Email Address:

• When selecting options for poker sheet, please keep in mind the prices are PER PARTICIPANT. There are two separate poker sheets available. Selecting 1 poker sheet will give you the option of either sheet, selecting 2 poker sheets will give you one of each.

• * You must pick up your packet: Please choose a pickup location --Choose-- Mercer Area Chamber of Commerce Hurley Area Chamber of Commerce Great Northern Motel

• Fee

  Type	Fee
  1 Poker Sheet - Pay Pal	$24.00
  2 Poker Sheets - Pay Pal	$34.00
  1 Poker Sheet - Check	$20.00
  2 Poker Sheets - Check	$30.00

Added information

• Packets can be picked up at the Mercer Area Chamber of Commerce on: Thursday, October 10th from 8am-4pm Friday, October 11th from 8am-1pm at the Mercer Chamber of Commerce, 2pm-When the pull is concluded normally around 6pm) at ATV/UTV Pull host Site hours may vary Hurley Chamber of Commerce: Thursday, 9am-4pm Friday, 9am-4pm Pickup is available at the Great Northern Hotel in Mercer on Thursday and Friday from 4pm-Midnight and Saturday Morning 9am-12pm

• All participants are required to sign a release waiver. *Riders under 18 are required to have a parent or guardian's signature as well.

WAIVER REQUIRED

• In consideration of the services of the Mercer Area Chamber of Commerce Inc., the Mercer Dusty Loons ATV Club Inc. their agents, owners, officers, volunteers, participants, employees and all other persons or entities acting in capacity on their behalf (hereinafter collectively referred to as Mercer Area Chamber of Commerce, Inc. I hereby agree to release and discharge Mercer Area Chamber of Commerce Inc, on behalf of myself my children, my parents, my heirs assign, personal representative and estate as follow: I acknowledge that certain known and unanticipated risks which could result in physical or emotional injury, paralysis, death or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

• The risks include among other things, Collision with other riders or objects along the trails, walls or other fixed objects: falling down; my own equipment failure or the failure of other’s negligence: objects or conditions on the surface that my cause me to fall: broken bones, sprains, head, neck and back injuries: abrasions’ and bruises. Furthermore, employees and volunteers have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities. They may give inadequate warnings or instructions and the equipment being used might malfunction. I expressly agree and promise to accept and assume all the risks existing in this activity. My participation in this activity is purely voluntary and I elect to participate in spite of the risks.

• I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless the Mercer Area Chamber of Commerce Inc. from any and all claims, demands, or causes of action which are in anyway connected with my participation in this activity or my use of the Mercer Area Chamber of Commerce’s equipment or facility, including such claims which allege negligent acts or omissions of. Should the Mercer Area Chamber of Commerce Inc. anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

• I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating. Or else, I agree to bear the costs of such injury or damage. I further certify that I have no medical or physical conditions which could conditions which could interfere with my safety in this activity. Or else, I am willing to assume and bear the costs of all risks that may be created, directly, by any such condition. In the event that I file a lawsuit against the Mercer Area Chamber of Commerce Inc. I agree to do so solely in the state of Wisconsin. I further agree that the substantive law of that state shall apply in this action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.

• *

  By answering yes I agree to the participation waiver above and , I agree that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against the Mercer Area Chamber of Commerce Inc. On the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it and agree to be bound by its terms.

  • Yes
  • No

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