Please Print and sign this form

Please Print and sign this form then return to KMA racing

2008

Coens Pond Snowmobile Watercross Training Permit

Dates of Use:

May 10^th – May 17^th – May 24^th – May 31^st – June 7^th – June 14^th – June 21^st –July 5^th (noon till 3:00) July 12th – August 9^th – August 16^th – August 23^rd August 30^th - September 6^th September 13^th September 20^th

Time of Use: 12:00 noon to 5:00 p.m. unless noted above

Please note these dates Can change – check the web site for any possible changes before practice

www.kmaracing.org click on Coen’s Pond info

Permit Holder Information:

PLEASE PRINT

Last Name:________________________________________

First Name:________________________________________

Date of Birth:______________________________________

Address: __________________________________________

City/State/Zip_____________________________,_____________________________,___________

Telephone:______________/____________/_____________

Email address: __________________________________________

I, the above permit holder agree to the dates and times listed on the permit above and understand this permit can be revoked at any time by the Burnett County Sheriff’s Office or by a request from the Dale Coen family to the Sheriff’s Department for my miss use of this permit. I also agree that I am responsible for myself and my crew I have with me and I hold all parties harmless from any accidents or injuries involved directly or indirectly before, during or after any of these practice dates.

Permit Holder Signature:____________________________________________________Date:___________

Parental Consent if under 18__________________________ _________________________________

Print Name Signature

Please fill out, sign and return with your user fee to KMA Racing as soon as possible. This must be returned before you will be allowed to practice. Anyone who violates any rules will be bared from practice.

Mail To:

KMA Racing Dale Coen Eric Peterson Arlen Peterson

207 1^st Ave.S. 715-327-4617 715-781-4840 715-497-2222

Frederic, WI 54837