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The Mother Road Ride Rally^SMJune 14-25, 2017

POLISH & CLEAN YOUR MACHINE------------THEN DO THE RIDE IN SEVENTEEN

YOU MAY REGISTER ANYTIME

REGISTRATION CLOSES MAY 25th

ITINERARY'S WILL BE SENT OUT JANUARY 1ST

Each person who registers gets: MOTHER ROAD RIDE RALLY RIDE PIN---MRRR JACKET PATCH--Visit Walnut Canyon National Monument-- MANY RT 66 MUSEUMS---RIDE THRU PAINTED DESERT & PETRIFIED FOREST---SPECIAL GROUP PICTURES-- RIDE DVD WITH PICTURES LETS YOU RELIVE THE RIDE---RIDE ITINERARY---FREE AWARDS DINNER AT END OF RIDE-- full set of Route 66 maps (if ordered), and other Route 66 'goodies.' Note: We must have a SIGNED Disclaimer in our files to send you all the registration materials. Scroll to end to find Disclaimer form. Print it, sign and then fax or mail to us. The ride is one way-westbound. You can easily travel at your own pace. You are not hostage to a ride leader, but there will be a Rallymaster to lead you across RT 66. Click here for more detailed information and answers to frequently asked questions about this event.

Those that would like to PAY BY CHECK print out these pages with release form sign and mail with a CHECK.

Make check payable to RIDE RT 66 LLC. Thank You.

If you would like a BROCHURE send me your postal mailing address to george@rideRT66.com THANK YOU.

Policies: Hitchhiking NOT allowed. Passengers are by invitation of riders only.

This is a "closed event." All bikes or Car's must be properly registered to ride in the Rally.

Privacy Policy: All information gathered for the event is kept within the group by Ride Rt 66, LLC and is not shared with any other company.

Note: A pre-departure dinner is held the night before the Rally. Details will be in the Rally Packet.

Should you have a change in plans, you can always get a full refund. There isn't a 'cut off' date for a refund, just return your registration materials to us for a prompt, no hassle refund. An option is to roll-over your registration to next year’s rally. A roll-over is allowed once, and if not used that next year, no refund is given. There is no on-site, day of departure registration.
Your registration must be in our office by May 25th.

Where did you hear about the Mother Road Ride Rally
what magazine___________Brouchure________ Are you a repeat Offender_______
What Web Site_____________Other___________

Please PRINT THIS PAGE and THE RELEASE AND INDEMNITY FORM AT THE BOTTOM fill out the following information then MAIL OR FAX.                        The *indicates required information.

First Name*_______________________ Last Name*____________________________

Address*_______________________________________________________________

City*_________________________ State*______________ Postal Code*_____________

Country*________________________________________

Daytime Phone___________________________________

Night Phone______________________________________

Your E-Mail Address________________________________

ADD YOUR START CITY FROM LIST BELOW______________________________________________

Willowbrook IL----Springfield, IL----St. Louis, MO---Springfield, MO--Miami, OK---Elk City, OK--
Santa Rosa, NM---Gallup, NM---Flagstaff AZ---Kingman, AZ-- OTHER_____________________________

ADD YOUR STOP CITY FROM LIST BELOW_______________________________________________

Santa Monica, CA----Needles CA----Kingman AZ---Flagstaff AZ---Gallup, NM---Santa Rosa, NM
Elk City, OK---Miami, OK--- Springfield MO----St Louis, MO---Springfield, ILL.--OTHER________________

Car or Motorcycle Brand/Model_________________________________________________________

Check here ⃝   If you’re a Repeat Offender.
Check here ⃝   If this is your 5^th or more Mother Road Ride Rally
Check here ⃝ If this is your 10^th or more Mother Road Ride Rally
Check here ⃝ If this is your 15^th or more Mother Road Ride Rally
Check here ⃝ If this is your 20^th or more Mother Road Ride Rally

Emergency Contact NAME & PHONE Number_____________________________________________________

Anything else you would like us to know!_______________________________________________________________
___________________________________________________________________________________________________
_IF YOU ARE 62 OR OLDER DO YOU HAVE A NATIONAL PARK PASS (CIRCLE) --YES NO __________________________________________________________________________________________________

BE SURE TO FILL out the above form AND to read and sign the Disclaimer and Release at the
bottom of this page. We need to have these TWO forms in our file before we can send you all your registration materials.
Mail or fax these forms to us.

Phone: Cell 352-684-5293 | E-Mail: rally@rideRT66.com

Fax 800-923-5309

PLEASE SIGN AND RETURN to Ride RT 66 LLC 12415 Linden Drive spring Hill Florida 34608

RELEASE AND INDEMNITY AGREEMENT PLEASE READ IT BEFORE SIGNING BELOW

I hereby give up all my rights to sue or make any claim whatsoever against the officers, employers or agents of Ride RT 66, LLC of Spring Hill Florida, sponsors and all other persons, participants or organizations conducting or connected with the event* for any injury to property or person I may suffer, including but not limited to crippling injury or death, whether such injury arises while I an preparing for or participating in the event or while I am upon the event premises.

I know the Risks of danger to myself and my property while participating in the event and while upon the event premises and relying upon my own judgment and ability, 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.

My Car or motorcycle meets all noise, insurance and registration requirements for the State in which it is licensed.

Operator Signature__________________________________________________________________________________

Print Name____________________________________________________________________Date____________

Passenger Signature______________________________________________________________________________

Print name_____________________________________________________________________Date_____________

Relationship to rider (Spouse,Relative, Friend)______________________________________.

*The Annual Mother Road Rally

BE SURE TO FILL out the above forms AND to read and sign the Disclaimer and Release form. We need to have these TWO FORMS in our file before we can send you all your registration materials. Mail or fax these forms to us. There is a print button at top of this page. Thank you.

Registration $199.00 WITHOUT MAPS CLICK BUY NOW BUTTON BELOW.

Registration $209.00 WITH MAPS CLICK THE BUY NOW BUTTON BELOW.

>Passenger Fee $35.00 CLICK THE BUY NOW BUTTON BELOW.

AN ADDITIONAL RIDE PIN FOR A PASSENGER ON A REGISTERED BIKE IS $6.95. CLICK BUY NOW BUTTON BELOW.

IF YOU WANT A PASSENGER REPEAT OFFENDER PIN $6.95 CLICK BUY NOW BUTTON BELOW.

RIDE WITH US AND ENJOY RT-66

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