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First Name: Last Name: Race License #: Tel: Cell: Email: Address: City: State: Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Code: Motorcycle Raced: Year Classes Raced: Select Class 1000cc Superstock 750cc Superstock 600cc Superstock Lightweight Twins Club/Organization: Select Club AFM CCS CMRA CRA MRA OMRRA WERA WMRRA WSMC SMRI ASRA Exhaust Purchased From: Invoice Number: Purchase Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Motorcycle Raced: Year Classes Raced: Select Class 1000cc Superstock 750cc Superstock 600cc Superstock Lightweight Twins Club/Organization: Select Club AFM CCS CMRA CRA MRA OMRRA WERA WMRRA WSMC SMRI ASRA Exhaust Purchased From: Invoice Number: Purchase Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Motorcycle Raced: Year Classes Raced: Select Class 1000cc Superstock 750cc Superstock 600cc Superstock Lightweight Twins Club/Organization: Select Club AFM CCS CMRA CRA MRA OMRRA WERA WMRRA WSMC SMRI ASRA Exhaust Purchased From: Invoice Number: Purchase Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Motorcycle Raced: Year Classes Raced: Select Class 1000cc Superstock 750cc Superstock 600cc Superstock Lightweight Twins Club/Organization: Select Club AFM CCS CMRA CRA MRA OMRRA WERA WMRRA WSMC SMRI ASRA Exhaust Purchased From: Invoice Number: Purchase Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Motorcycle Raced: Year Classes Raced: Select Class 1000cc Superstock 750cc Superstock 600cc Superstock Lightweight Twins Club/Organization: Select Club AFM CCS CMRA CRA MRA OMRRA WERA WMRRA WSMC SMRI ASRA Exhaust Purchased From: Invoice Number: Purchase Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Motorcycle Raced: Year Classes Raced: Select Class 1000cc Superstock 750cc Superstock 600cc Superstock Lightweight Twins Club/Organization: Select Club AFM CCS CMRA CRA MRA OMRRA WERA WMRRA WSMC SMRI ASRA Exhaust Purchased From: Invoice Number: Purchase Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2008 Race Contingency Program Requirements 1) You must purchase and use a LeoVince exhaust system on the motorcycle in each of the classes you are applying for contingency in. You are eligible for contingency awards up until December 31st, 2007. 2) The LeoVince Race Contingency Application must be submitted before June 30, 2007 to be eligible for contingency awards. 3) LeoVince decals must be displayed prominently on both sides of the motorcycle to be eligible for contingency awards. 4) LeoVince USA must be listed as a sponsor on all race registration forms at each event. 5) The technical inspector at each race event must check and properly mark your contingency eligibility forms to ensure you are eligible to receive the contingency awards. It is your responsibility to inform the technical inspector of your eligibility for the contingency award. 6) Contingency certificates are only redeemable through LeoVince USA. 7) Contingency certificates must be redeemed by December 31st, 2007. The face value of the certificate can be used to purchase any LeoVince product at regular retail price. Eligible Series, Classes and Payouts Regional Series AFM, CCS, CMRA, CRA, MRA, OMRRA, WERA, WMRRA, WSMC LW, MW, HW and Open Superstock (or their equivalents) Expert and Novice (Amateurs) 1st-$75, 2nd-$50 and 3rd-$25. National Series ASRA/CCS National Series Sportbike, Superbike and Unlimited Grand Prix Expert 1st-$150, 2nd-$100 and 3rd-$50 WERA National Challenge Series 600, 750 and Open Superstock Expert 1st-$150, 2nd-$100 and 3rd-$50 WERA National Endurance Series MW, HW Superstock and LW, MW, HW Superbike 1st-$150, 2nd-$100 and 3rd-$50 Please check with your organization or club for the exact class name. Each organization may have a different class name. Please call us when you are eligible for a contingency award so we can verify and expedite your awards. AGREEMENT AND RELEASE By clicking below I acknowledge that I have read all the Contingency Requirements and agree to perform all of them in order to be eligible for contingency awards. I agree to release LeoVince USA, SITO USA and its affiliates to use my name, photograph, likeness and racing results for advertising and public relations for a period of not less than two years from this date. I agree that I am fully aware of the hazards and dangers involved in motorcycle racing, and I hereby assume all risks. I agree to hold harmless and indemnify LeoVince USA, SITO USA, their employees and agents from all personal injuries and/or damage caused by my participation in motorcycle racing. I agree that this agreement binds me, my heirs, legatees, personal representatives and all those claiming through me.