Provide a list of any PRESCRIPTION medications you take or any acute or chronic medical conditions that you have. This information will be given to medical personnel in the event of a medical emergency. Enter "NONE" if this does not apply to you.
Provide a list of dietary restrictions or other needs you have. Please include such things as allergies, vegetarian nutritional restrictions, and intolerances (i.e., lactose intolerance).
Please read carefully and confirm with your initials that you agree with all of the statements where 0 to 4 characters are required to be entered. Enter the information as requested for the remaining fields where detailed information is requested.
I CERTIFY that I have the health, fitness, strength, stamina, coordination,and balance to be successful. I will come to
DIRTYforGOOD rested and ready to learn.
I CERTIFY that I will secure repatriation insurance to cover the return of myself and my motorcycle should this become necessary. The organizers have carried such insurance year-round since 2010 and have never needed to use it. This type of insurance provides peace of mind when traveling in remote areas. Crisis intervention, rescue, and helicopter rides are not cheap. You can opt for a short term policy if desired.
I will come to the DIRTY FOR GOOD Off-Road Riding Camp with proper riding gear: DOT-approved full-face, modular or dual sport/dirt riding helmet; eye protection (goggles or face shield); chest/back protection; elbow/shoulder protection; full-fingered gloves; dirt/dual sport/adventure boots; and a hydration system.
NOTE: Armored, motorcycle-specific road gear is NOT acceptable unless it is adventure riding gear. For Dirt/Dual sport/Adventure specific riding gear, consider going to revzilla.com or cyclegear.com and look at their offerings. We can provide you with other online resources if needed.
I understand that I will pay the registration fee of $1,885 with a $400 non-refundable (but transferrable) deposit. Registration fees cover range assessment/skills practice on July 20, 2020, with two (2) certified female instructors who determine, monitor and adjust along the way what each of us is capable of riding. These registration fees also include lodging two (2) riders per room or camping, breakfast, healthy lunch items for the trail (which will be self-packed each day). The dates these fees cover are July 20, 2020, through the morning of August 3, 2020.
My final payment must be made by July 1, 2020
I understand that the North East Backcountry Discover Route is not intended for beginner riders. Successfully riding this route requires a minimum of INTERMEDIATE SKILLS and successful completion of at least one formal off-road rider training course.
I understand that dual-sport/adventure motorcycle riding involves inherent risk. I accept this risk and hold harmless all organizations, lodging/camping sites, restaurants, ride guides, instructors, volunteer staff, and locations along the way. None of these entities are responsible for my PERSONAL SAFETY.
Please provide us with a summary of your off-road riding experience. Please include in this list the year, length of training, and the name of the training school you attended most recently. If you have a training class scheduled before DIRTYforGOOD, include that as well.
I agree to bring a street-legal, mechanically sound Dual Sport or Adventure bike to DIRTYforGOOD. It can be one that I own, borrow or rent. A 250cc – 400cc, light-weight dual-sport model is recommended. The motorcycle should be equipped with handguards, a skid plate, and depending on the
model, engine guards. The motorcycle should be able to operate for at least 100 miles on one gas tank fill, or you will be required to bring an auxiliary container for carrying added gas. The motorcycle should be fitted with DOT knobby tires with at least 90% of the tread remaining rated at least 50% dirt, and 50% road will provide the best ride for our conditions. We advise that you use HEAVY DUTY tire tubes if running with tubed tires. You must provide a current registration or rental paperwork for the model you bring to the DIRTYforGOOD site.
If you know what bike you will be using, please list it below by giving MAKE, MODEL, and ENGINE SIZE. If you do not know what bike you will be using, enter "DO NOT KNOW".
I understand and agree, in addition to my registration fee, I MUST raise or self-pay a minimum of $300.00 for WMF's two (2) chosen 501(c)(3) charitable organizations.
(1) Final Salute, Inc.: a Female Veteran's organization to provide housing for Female Veterans
(2) the Backcountry Discovery Route: an organization that maintains and develops dual-sport/adventure riding routes that bring much-needed business revenue to rural communities.
I understand that WMF, Inc. will not use these funds raised by the riders for its overhead or operating expenses.
I agree to not mix any substances that would interfere with my judgment, vision, physical or mental condition including but not limited to alcohol, over-the-counter or prescription drugs with the riding experience.
I agree to bring any of my concerns, especially concerns revolving around safety, immediately to the instructors or the DIRTYforGOOD
organizers Gin Shear & Sue Slate.
I understand that, as long as this registration form is, it will be reviewed again and signed again during orientation in Hancock, NY, no later than 7:30 AM on July 20, 2020.
I understand and agree with the use of my image, as shown below. The choices checked in the list below are items that have my consent.
DURING CHECK-IN AND ORIENTATION YOU WILL BE ASKED TO REVIEW AND SIGN THIS DOCUMENT AGAIN ALONG
WITH READING AND SIGNING OTHER WAIVERS OF INDEMNIFICATION.
This field is for validation purposes and should be left unchanged.