2017 Off-Road Contingency Registration Form

THIS FORM MUST BE COMPLETED IN FULL TO RECEIVE CONTINGENCY!

* = Required field.

This agreement is made this 9/20/2017, by and between Yamaha Motor Corporation, U.S.A. and:

Rider's Name

First Name:

Middle Initial:

Last Name:

Rider's Legal Name (if different)

First Name:

Middle Initial:

Last Name:

Address:

City:

State or Province:

Zip Code:

Date of Birth:

Social Security Number:

Email Address:

I would like to receive information by email about Yamaha. My information will not be sold, nor distributed to anyone outside the Yamaha network.
Yes No

Telephone (Mobile):

I want to receive text alerts from Yamaha on my mobile phone.
Yes No

Telephone (Home):

Please provide your social media information below so we can follow and keep up with you throughout the season.

Facebook Web Address:

Twitter Handle:

YouTube Channel:

Instagram Channel:

List series and classes in which you plan to compete (80 characters max.):

List the 2016* or newer model YZ/WR motorcycle(s) you'll be racing by entering frame Vehicle Identification Numbers (VIN - 17 digits).

VIN 1:

Model:

VIN 2:

Model:

VIN 3:

Model:

VIN 4:

Model:

In the event the warranty registered owner will not be competing, but is sponsoring a rider, please complete the following:

Warranty Registered Owner's Name:

First Name:

Middle Initial:

Last Name:

Telephone:

Relationship to Rider:

Rider agrees that Yamaha shall have a license to use rider’s name, signature, initials, likeness, photograph and similar materials in connection with the advertisement, promotion and sale of products distributed by Yamaha and any subsidiary of Yamaha.

Riders must submit a 2017 Contingency Registration Form by November 30, 2017 to be eligible for contingency earned in 2017.
Upon 2017 registration approval, new bLU cRU members will receive a reloadable Yamaha bLU cRU debit card within 4 to 6 weeks.
Professional Supercross, Motocross and Flat Track winners must complete an IRS Form W-9 in order to receive payment.
All registered winning riders will be issued credit to their reloadable Yamaha bLU cRU debit card after Yamaha received confirmation of results from promoter and rider has completed a registration form and valid IRS Form W-9.
Only 2016 or newer U.S. YZ and WR models purchased in the United States are eligible.
Winning riders must have a valid U.S. social security number to be eligible.
Contingency will be paid to the WARRANTY REGISTERED owner. If warranty registered owner will not be completing, but sponsoring a rider, contingency will be paid to the rider.
Race results must be received from race promoter within 30 days of event in order for contingency to be paid.

Yamaha will not pay an event when the promoter fails to submit results within 30 days of the event.
In cases of multiple divisions of the same class, Yamaha will pay one division as specified by promoter.
In cases of dual sanctioned events, rider will be paid for one event only.
Contingency will be paid on rider’s best finish in one class only, per registered machine.
There will be no multiple class payouts at the same event for the same machine.
There must be a minimum of five riders in a class to qualify for contingency.
The “Yamaha” logo must be displayed on the left and right side of the motorcycle and the “bLU cRU” logo must be displayed on the front number plate of all machines to be eligible.
The original color plastic components must remain on all units to be eligible.
Go to www.yamahabLUcRU.com for more details.
Program details subject to change without notice at Yamaha’s sole discretion.

I have read, understand, and agree to the contingency program terms as listed.

AGREE

* = Required field.

Yamaha Motor Corporation, U.S.A. 6555 Katella Avenue, Cypress, CA 90630 Attn: Contingency
Phone: 714-761-7509 | Fax: 714-229-7974 | Email: racingcontingency@yamaha-motor.com

2017 Off-Road Contingency Registration Form

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