The Mother Road Ride RallySM June 8-20, 2021 THE RIDE FOR EVERYONE THE RIDE FOR TWENTY-ONE
YOU MAY REGISTER ANYTIME
REGISTRATION CLOSES APRIL 20
ITINERARY'S WILL BE SENT OUT JANUARY 1ST
Each person who registers gets: MOTHER ROAD RIDE RALLYRIDE PIN---MRRR JACKET PATCH--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 aSIGNED Disclaimerin our files to send you all the registrationmaterials.Scroll to end to find Disclaimer form. Print it, sign and then 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. Registration $209.00 WITH MAPS Passenger Fee $35.00 $199.00 Without Maps 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.
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 APRIL 20
REPEAT OFFENDERS If all your information is the same Don’t need to fill out form NEED the last Year you rode_______. Sign release & Date send check or pay-pal
WHERE did you hear about the Mother Road Ride Rally what magazine___________Brouchure________ Are you a repeat Offender_______ What Web Site_____________Friend___________Other__________ Please PRINT THIS PAGE and THE RELEASE AND INDEMNITY FORM AT THE BOTTOM fill out the following information then MAIL. The *indicates required information. First Name*_______________________ Last Name*____________________________ Address*_______________________________________________________________ City*_________________________ State*______________ Postal Code*_____________ Country*________________________________________
Night Phone______________________________________ Your E-Mail Address________________________________ ADDYOURSTART CITY FROM LIST BELOW______________________________________________
WillowbrookIL----Springfield, IL----St. Louis, MO---Springfield, MO--Miami, OK---Oklahoma 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 Oklahoma 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 5th or more Mother Road Ride Rally Check here ⃝ If this is your 10th or more Mother Road Ride Rally Check here ⃝ If this is your 15th or more Mother Road Ride Rally Check here ⃝ If this is your 20th or more Mother Road Ride Rally Emergency Contact NAME & PHONE Number_____________________________________________________
Anything else you would like us toknow!_______________________________________________________________ ___________________________________________________________________________________________________ __________________________________________________________________________________________________
BE SURE TO FILL out the above form ANDto 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 these forms to us. Phone: Cell 352-684-5293 | E-Mail: rally@rideRT66.com
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.
Relationship to rider (Spouse,Relative, Friend)______________________________________.
*The Annual Mother Road Rally
BE SURE TOFILL out the above forms ANDto 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 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.