You can complete this form or you can download, print and submit the PDF form: –> Wertz Warriors New Rider App Oct 2015 New Rider Application Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Other PhoneEmail AgeOccupationCurrent Wertz Warriors SponsorMedical TrainingYesNoWhat Type of medical training?Criminal Offense*YesNoHave you been convicted of any criminal offense?Snowmobile Year MadeWhat year was your snowmobile manufactured?Snowmobile MakeSnowmobile ModelType of Fuel Required87 Unleaded89 Unleaded91 UnleadedDieselEthanolSugar WaterYears of snowmobile experienceDo you have experience riding with large groups of peopleYesNoTypical Style of RidingWhat size group of ridersMost Miles ridden in one dayWere you the group leader?YesNoAre you capable of riding over 200+ miles per day?YesNoPlease explain why you cant ride over 200 miles per dayMinimum amount of donations required to be a Wertz Warrior First Year: $2,000 Second Year: $2,750 Every year thereafter: $3,500What type of fundraiser do you plan to have to achieve your fundraising requirements?*What area or location do you plan on having your fundraisers at?do you know of a location, within our route parameters, that would like to be an official stop on our ride? If yes, please provide their contact info.*Please note that there is a minimum requirement of $2,500 to be a stop on the Wertz Warriors ride.Will your fundraising efforts be shared between you and your sponsor?YesNoAre you able to help or attend a Wertz Warriors fundraising function if available?YesNoAre you able to attend the General Membership meetings that are held in Mt. Clemens prior to the ride?YesNo*Although the meetings are not mandatory, you are encouraged to attend in order to fully understand the events that will take place during the ride and so you can ask any questions that you have. Do you understand that your sponsor will be held responsible to make sure that you have a basic understanding of the rules, regulations and trail etiquette required during the ride?*YesNoDo you understand that your sponsor will be held responsible to make sure that you have a basic understanding of the rules, regulations and trail etiquette required during the ride? Please keep in mind that an elected board member will also be required to provide any other required information that you will need. Please understand the purpose of the Wertz Warriors Snowmobile Endurance Ride is to continually pursue the goal of raising donations to the amount of or exceeding the amount required to cover the cost of the actual winter games. This is week long effort, of which as a “Wertz Warrior” you are required to take part in. Furthermore, within this week long ride, your attendance is a mandatory requirement at each “official” stop and or event whether you are a rider or on the support crew, without exception! We will attempt to cover as many miles as possible on the snowmobiles even if the conditions are less than favorable. However, as conditions dictate, our scheduled route and or stops will be completed each day though out the week in whatever support vehicles are available to us. It is also your understanding that we are a group, and being such, every effort is made to make decisions that are in the best interest of our group. These decisions are made by the elected board members. Once these decisions are made by the board, whether you agree or not, it is your responsibility as a Wertz Warrior to abide by that decision. Opinions and suggestions will always be attended to at the appropriate time and place. Your individual actions while on this ride are a reflection on all of us Warriors. Our reputation and future existence depends mainly on our behavior that we project to others as we proudly wear our “Green Jackets”. Never let the Wertz Warrior name be placed in jeopardy by the actions of yourself or any other fellow Warriors. Remember who we are and why you became a Wertz Warrior.Agreement* I accept and agree If you understand and agree to the statements and guidelines that have been outlined for you in this Wertz Warriors application please sign and date the bottom of this page. Have your sponsor sign it and they will submit it to the Board of Directors for approval. This iframe contains the logic required to handle Ajax powered Gravity Forms.