2012 YZ/WR Contingency Registration Form

THIS FORM MUST BE COMPLETED IN FULL TO RECEIVE CONTINGENCY!
SUBMIT ONLY ONE FORM FOR THE ENTIRE 2012 SEASON!

* = Required field.

This agreement is made this 2/7/2012, 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:
Click here to choose a date 		* Social Security Number:
   - -
* Email Address:
* Telephone:      
( )  - 		 
List series and classes you plan to compete in during the 2012 season (80 characters max.):
List the 2011 or newer model YZ/WR motorcycle(s) you'll be racing by entering frame Vehicle Identification Numbers (VIN - 17 digits) below beginning with "JYA."
* Model [ ]
  Model [ ]
  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.
• 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.
• Riders who have not submitted a 2012 Contingency Form by November 30, 2012, will not be eligible for contingency earned in 2012.
• Winning riders must redeem YZ Bucks certificates with a Yamaha dealer within 45 days of the issue date. Expired certificates will not be honored.
• Only 2011 or newer YZ/WR models are eligible.
• Only U.S. models purchased in the United States are eligible.
• Winning riders must have a valid U.S. social security number to be eligible.
• Professional Supercross, Motocross, and Flat Track winners must complete an IRS Form W-9 in order to receive payment.
• Contingency will be paid to the WARRANTY REGISTERED owner. However, if warranty registered owner will not be competing, but sponsoring a rider, contingency will be paid to the rider.
• All contingency certificates earned in 2012 must be redeemed by December 31, 2012.
• 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 and original color plastic components must remain on all machines to be eligible.
• AMA professinal Supercross, Motocross, and Flat Track winners will be paid by check.
• All other winning riders will receive "YZ Bucks" certificates, redeemable for parts and merchandise at participating Yamaha Dealers.
• Program details subject to change without notice.
  Contact Yamaha Racing Contingency Dept. phone: 714.761.7509, fax: 714.229.7974 or email to: racingcontingency@yamaha-motor.com
You have read, understand, and agree to the contingency program terms as listed. *
* = Required field.
Yamaha Motor Corporation, U.S.A. 6555 Katella Avenue, Cypress, CA 90630 Attn: Contingency
Phone: 949-789-2969 Fax: 714-229-7974 Email: racingcontingency@yamaha-motor.com