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