Membership Sign Up

* = Mandatory field

First Name*
Middle Name*
Last Name*
D.O.B.*

Gender Male Female
T-shirt Size*

Home Address*
Line 1
Line 2
City
St./Prov.
Zip
Country

Contact Information
Evening Phone*
Pala Raceway wants to be able to contact someone in case of an emergency that will be able to arrange to return your bike and vehicle to you and to let them know when you have been transported to a medical facility. Health Insurance provider and Primary Care physician information will help you get the proper medical care quicker in case of a serious emergency.
Cell Phone
E-mail Address*
Emergency Contact*
Emergency Contact Phone*
Health Insurance*
Primary Care Physician
Primary Care Phone

Business Information
Occupation
Pala Raceway is always looking to support the people that support Pala Raceway and we utilize a network of contacts for projects that you and your company could be involved in.
Company Name
Business Phone

Bike Information
Bike Manufacture
Pala Raceway will be stocking parts and accessories in a pro shop that will allow riders to fix mechanical failures and we want to know what you ride to try and stock parts for your bike. Pala Raceway also receives donations from many aftermarket companies that we will forward on to our riders at random times throughout the year.
Bike Model
Bike Year
Bike Number
Racing Class

Give Away Information
Pant Size Pala Raceway receives donations and promotional items from many clothing and gear manufacturers and we want to give it to you.
Jersey Size
Helmet Size
Boot Size
Glove Size

Vehicle Information (Used in case of an accident)
Vehicle Manufacture
Pala Raceway wants to be able to locate your vehicle in case of an emergency so we can return your bike and vehicle to you in a safe and timely manner.
Vehicle Model
Vehicle Year
Vehicle Color
Vehicle License Number

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