2012 Pivot Works Contingency Registration Form


This form must be completed in full to receive contingency!



* indicates required field


Rider's Name


* First Name:  

* Middle Name:  

* Last Name:  


Parent or Legal Guardian (if minor)


  First Name:  

  Middle Name:  

  Last Name:  


Contact Information


* Address:         

* City:      


* State:             

* Zip code:       


* Date of Birth:  

* Email Address:     


* Home Phone:  

Cell Phone:  


* List series and classes you plan to compete in for the 2012 race season:



Contingency rewards will be shipped within 7-10 business days once Pivot Works receives and approves “official” series results and a picture of your machine containing the Pivot Works logo from YOU.


Pivot Works contingency program ends December 31st, 2012 and all contingency rewards earned in 2012 must be redeemed within 30 days after program end date.


Rider agrees that Pivot Works maintains the right to use rider’s name, likeness, photography and all similar material in connection with advertisement, promotions and the sale of products by Pivot Works.


Rider understands and agrees that he/she is an independent contractor and not an employee of Pivot Works and is not entitled to any of the legal benefits of employment from Pivot Works.


Rider agrees that Pivot Works shall have no liability for injuries or damages suffered by rider or for injuries or damages caused to third persons by rider during the term of this agreement.


Any rider falsifying claims will automatically be disqualified from the contingency program.


Any dispute arising from this program must be resolved under the laws of Iowa with a venue of Polk County, Iowa USA.


You have read, understand and agree to the contingency program terms as listed.


* AGREE *