ATTENTION UTAH SBA RACERS: MASTERS OF THE MOUNTAINS ROUND #2 2012 REGISTRATION Please fill out the attached registration form with credit card number and FAX to WERA before midnight, May 14 Also attached is a reference sheet with WERA -> UtahSBA class conversions and a weekend schedule showing UtahSBA classes. You can sign up for any classes (the more the better!), but your Masters of the Mountains points will be score based on the class conversion sheet attached. Email: wera@wera.com Phone: (770) 720-5010

Fax: (770) 720-5015 Snail: WERA Motorcycle Roadracing 2555 Marietta Hwy. #104 Canton, GA 30114 ** To score WERA points your bike must conform to the WERA rulebook! *** To score UtahSBA points, your bike must conform to the UtahSBA rulebook! The WERA on-line registration is for anyone with a current WERA Motorcycle Roadracing License and ID# - although many of the USBA riders have ID#s with us if they try to enter on-line they will be charged a full license since their weekend license would have expired on the Monday after our event in 2011. The best way for the USBA riders to enter is to fill out the Master Sprint Entry Form which you can find under our “Forms” link on the web site – fax it in with a cc# or mail it with a check. We will need to make sure they arrive here by midnight on May 14th. The fees for the weekend are: Gate Fee: $20.00 for Saturday/Sunday; $10.00 for Sunday only 1st Class: $95.00 Pre - $100.00 Post 2nd Class: $75.00 Pre - $80.00 Post Additional: $65.00 ea. Pre - $70.00 ea. Post The Endurance is $600.00 per Team Pre and $625.00 Post per Team A transponder Rental is $60.00 for the weekend and we use the AMB System. If they are interested a 12 month WERA Motorcycle Roadracing License is $110.00 and it will be good for 12 months from the date of purchase. There is no practice fee – if a rider enters a race his practice is included. The Schedule for the event is up under our “Schedules” link on the web site. Quick links: WERA website -> www.wera.com WERA rulebook -> http://maps.wera.com/rulebook/?x=1098 WERA schedule -> http://maps.wera.com/pdfs/2008Schedules/miller052012.pdf  

WERA SPRINT MASTER ENTRY FORM Track ______________________ Event Date ___________ Comp# _______

Name ________________________________ Address _____________________________

City ______________________ State ______ Zip _____________ Phone # ( ) ________-_____________

Sponsor(s) _______________________________________________________________________________

________________________________________________________________________________________

Emergency Contact Name ________________________________ E.C. Phone ( )____________________ Class Brand/cc Fees Class Brand/cc FeesA Superstock ________________ __________ B Superstock ________________ __________ C Superstock ________________ __________

D Superstock ________________ __________ E Superstock ________________ __________

Womenss SS ________________ __________ Heavyweight Twins SS ________________ __________ Lightweight Twins SS ________________ __________

Senior SB - HW MW ________________ __________

Formula 1 ________________ __________ Formula 2 ________________ __________ Formula 3 ________________ __________

Clubman ________________ __________ Heavyweight Twins SB ________________ __________

Lightweight Twins SB ________________ __________

A Superbike ________________ __________ B Superbike ________________ __________

C Superbike ________________ __________

D Superbike ________________ __________

Total Race Fees _________

Transponder _________

Membership _________

Riders School _________

Discount <_______>

Total Fees _________

Cash _________

Check _________

Charge _________

Credit(s) _________

Total Collected _________

Signature ___________________________________ Registrar__________________________

CONSENT FOR DISCLOSURE OF CONFIDENTIAL INFORMATIONI hereby consent to the disclosure of information from the patient health care records of the above rider to WERA Motorcycle Roadracing, or their representatives, for the purpose of their analysis and use.

164.508 (HIPAA Authorization Requirements for Release of Protected Health Information), 42 CFR Part 2 (Federal Requirements for Release of Alcohol and/or Drug Abuse Program Records), 38 CFR Part 1 (Release of HIV/AIDS, Sickle Cell Anemia, Drug Abuse, Alcoholism or Alcohol Abuse Records by the

conference reports, medical, surgical, pathological, psychiatric, psychological, pharmaceutical, school, vocational, social service, and day service reports. I understand that information disclosed may include reference to or treatment for alcohol/drug abuse, HIV/AIDS and sickle cell anemia diagnoses, and/or emotional illness or developmental disabilities. Records of child and adolescent patients may include reference to parental emotional illness, including the treat-ment of alcohol and drug abuse. I understand that any HIV/AIDS, sickle cell anemia information, and/or alcohol abuse/treatment information records cannot be redisclosed without my express written consent or as otherwise permitted by 42 CFR Part 2 or 38

I further agree that a photostat copy of this consent shall be considered as ef fective for a period of two (2)

already been taken in reliance upon this authorization and release of medical records. I also understand that I have the right to refuse to sign this authorization and release of medical records. I understand I may inspect and receive a copy

Bike # Status

I.D. #

Exp. Date

Transponder #

Heavyweight Solo 20 ________________ __________

Mediumweight Solo 20 ________________ __________ Lightweight Solo 20 ________________ __________

250 GP ________________ __________

350 GP ________________ __________

500 GP ________________ __________

Vintage 1 ________________ __________ Vintage 2 ________________ __________

Formula 500 ________________ __________

Vintage 3 ________________ __________

Vintage 4 ________________ __________

Formula 2stroke ________________ __________

Vintage 5 ________________ __________

Vintage 6 LW HW _________________ __________ Vintage 7 HW _________________ __________ Vintage 7 MW _________________ __________

Minis - 80cc 50cc (Circle One) _________________ __________

Other/Practice _________________ __________

Credit Card Number:_________________________________

Cardholder Name:___________________________________

Signature:_________________________________________

Exp Date:______________

UtahSBA Round #2 2012

Complete and FAX to (770) 720-5015

❑ Open Superstock ❑ Combined GTO

❑ 250GP

❑ MW Superstock

❑ Women’s GTO

❑ HW Superbike ❑ Novice GTU

❑ Formula 40

❑ Open Superbike ❑ Novice GTO ❑ Formula 5

❑ Moto3

❑ HW Superstock/

❑ Sportsman

❑ Twins GTO

❑ KoM GTO

❑ KoM GTU

❑ SuperTwins

❑ Twins GTU

❑ Combined GTU

WERA NATIONAL ENDURANCE SERIES

Please Print Legibly Track ________________________ Date ___________

Team Name ______________________________ Address _________________________________________

City ______________________ State ______ Zip _____________ Phone # ( ) ________-______________

Team Captain_______________________________ Team Owner____________________________________

Sponsor(s) ________________________________________________________________________________

_________________________________________________________________________________________

Frame #1______________________Frame #2______________________Frame #3______________________

Team E.I.N. or Team Owner SS#___________-_________-________________

Rider Name Hometown/State WERA ID#/Exp. Date Emergency Contact E.C. Phone#

1)_____________________ ____________/____ ____________/________ _________________ (_____)______-_______

2)_____________________ ____________/____ ____________/________ _________________ (_____)______-_______

3)_____________________ ____________/____ ____________/________ _________________ (_____)______-_______

4)_____________________ ____________/____ ____________/________ _________________ (_____)______-_______

5)_____________________ ____________/____ ____________/________ _________________ (_____)______-_______

Class________________________________ Motorcycle Brand_____________________ Displacement_________________

Rider Signatures: _______________________ _______________________

_______________________ _______________________ _______________________

Bike#________________

Team ID#_____________

Tran#________________

Total Race Fees _________

Misc./Practice _________

Membership _________

Total Fees _________

Credit Card Number:_________________________________

Cardholder Name:___________________________________

Signature:_________________________________________

Exp Date:______________

Cash _________

Check _________

Charge _________

Credit(s) _________

Total Collected _________

CONSENT FOR DISCLOSURE OF CONFIDENTIAL INFORMATIONI hereby consent to the disclosure of information from the patient health care records of the above rider to WERA Motorcycle Roadracing, or their representatives, for the purpose of their analysis and use.This consent is for the disclosure of all patient health care records whose confidentiality is protected by Federal laws, as defined in 45 CFR § 164.508 (HIPAA Authorization Requirements for Release of Protected

Health Information), 42 CFR Part 2 (Federal Requirements for Release of Alcohol and/or Drug Abuse Program Records), 38 CFR Part 1 (Release of HIV/AIDS, Sickle Cell Anemia, Drug Abuse, Alcoholism or Alcohol AbuseRecords by the Department of Veteran Affairs), and Secs. 146.81and 51.30, Wis. Stats. These records include reports and findings relating to care, evaluation, testing, history, progress, diagnosis, prognosis and treatment, includingsummaries, team conference reports, medical, surgical, pathological, psychiatric, psychological, pharmaceutical, school, vocational, social service, and day service reports. I understand that information disclosed may includereference to or treatment for alcohol/drug abuse, HIV/AIDS and sickle cell anemia diagnoses, and/or emotional illness or developmental disabilities. Records of child and adolescent patients may include reference to parentalemotional illness, including the treatment of alcohol and drug abuse.

I understand that any HIV/AIDS, sickle cell anemia information, and/or alcohol abuse/treatment information records cannot be redisclosed without my express written consent or as otherwise permitted by 42 CFR Part2 or 38 CFR Part 1. A general authorization for the release of medical or other information is not sufficient for this purpose.

I further agree that a photostat copy of this consent shall be considered as effective and as valid as the original. It is my specific intention that this informed consent and request shall be effective for a period of two (1)years or until completion of the purpose for which this consent was given, unless this consent is specifically withdrawn by me in writing. I understand that I may revoke this authorization at any time, except to the extent that actionhas already been taken in reliance upon this authorization and release of medical records. I also understand that I have the right to refuse to sign this authorization and release of medical records. I understand I may inspect andreceive a copy of the disclosed information. I have read all of the above and understand the nature of this release and certify that it accurately reflects my wishes.

❑ HW Superbike = Endurance GTO ❑ MW Superbike = Endurance GTU ❑ LWT Superbike = Endurance Lightweight No UtahSBA relay class for round 2

UtahSBA Round #2 20126-HOUR ENDURANCE

Complete and FAX to (770) 720-5015

2012 WERA National Challenge Series &Bridgestone/WERA National Endurance Series

Pirelli/WERA Sportsman Series WERA West RegionalMasters of the Mountain

Miller Motorsports Park May 19-20 Presented by - Lucas Oil Products

7:00am - 9:30am Registration Open7:45am - 9:45am Technical Inspection Open8:00am-9:40am Practice - Groups as follows (one round): 1) 600cc Experts 3) 750cc and Up Experts 2) 600cc and Up Novices 4) Lightweight Novices and Experts 9:40am-10:00am 600/C Superstock Expert Qualifying 10:00am-10:30am Endurance Practice10:30am-11:30am Lunch Break10:40am Riders Meeting - Pit Lane11:30am Round 4 Bridgestone/WERA National Endurance Series - 6 Hour

- Awards Presentation in Winners Circle -

8:00am - 9:30am Registration Open8:15am - 10:00am Technical Inspection Open8:30am - 11:00am Practice Groups as follows: 1) 600cc Experts 4) Lightweight Novices and Experts 2) 750cc and Up Novices 5) 600cc Novices 3) 750cc and Up Experts 11:00am - 12:00pm Lunch Break11:15am Riders Meeting - Winners Circle on Tower11:40am Chapel Service - Riders Meeting Room12:00pm Michelin/WERA National Challenge Series and Masters of the Mountain Races 4 laps unless marked otherwise 1) Open/A Superstock Ex & Nv, Am GTO 9) 125cc GP, Clubman

2) Senior Superbike/Formula 40 10) 600/C/MW Superbike, Nv GTU, HWT SS, Twins GTO

3) WSS, HWT SB, Super Twins, V6HW, V7MW 11) LWT SS, DSB, ESS Ex & Nv

4) 600/C/MW Superstock Expert - 8 laps 12) 750/B/HW Superstock Ex & Nv

5) 600/C Superstock Novice 13) LWT SB/Twins GTU, DSS Ex & Nv, Sportsman

6) KoM U, Formula 2 Ex & Nv 14) WERA/A/Open Superbike Expert - 8 laps

7) 750/B Superbike Ex & Nv, Am GTU, V7 HW 15) A Superbike Nv/Novice GTO, Formula 5,

8) Formula 1/KoM O Ex & Nv

-Awards Presentation in Winners Circle -

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Thanks to our sponsors!Bridgestone National Endurance Series

Pirelli Sportsman SeriesLucas Oil in WERA West

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era.com

Available National Contingencies:Bridgestone**, Continental, Dunlop, EBC Brakes, Held**, Hotbodies**,

Honda*, Performance Friction, Pit Bull, Silkolene, Suzuki**, Vortex, Yamaha**,

Check with registration for details and requirements on all contingencies.Some forms are not available at the track but are online.

* Requires sign-up on their website ** Requires a once a year form

WERA -> UtahSBA Class Conversions A SUPERSTOCK EXPERT & NOVICE and A SUPERBIKE EXPERT & NOVICE Unlimited OEM Displacement UtahSBA Open Superstock B SUPERSTOCK EXPERT & NOVICE and B SUPERBIKE EXPERT & NOVICE Up to 750cc multis (Superbike up to 770cc) Up to 1050cc 4 stroke triples(Superbike up to 1080cc) Up to 1000cc 4-stroke twins Unlimited singles Vintage 5 & 6 machines * 250cc GP machines are allowed in B Superbike. Ducati 1098 is allowed into B Superbike in Superstock trim. UtahSBA Heavyweight Superstock C SUPERSTOCK EXPERT & NOVICE and C SUPERBIKE EXPERT & NOVICE Up to 650cc 4-stroke multis Up to 675cc 4-stroke triples Up to 1200cc 4-stroke air-cooled twins Up to 850cc 4-stroke water-cooled twins Up to 550cc 2-stroke multis Unlimited singles Vintage 5 machines *Aprilia Tuono, KTM SuperDuke, Honda VTR1000F and Suzuki SV1000 are allowed in C Superstock and Superbike in Superstock trim only for both classes slicks are allowed in Superbike. UtahSBA Middleweight Superstock D SUPERSTOCK EXPERT & NOVICE and D SUPERBIKE EXPERT & NOVICE Up to 490cc water-cooled multis Up to 700cc 4-stroke water-cooled twins with 3 valves or less per cylinder Up to 600cc air-cooled multis & water cooled twins with more than 3 valves Up to 883cc 4-stroke air-cooled twins Up to 775cc singles based on Formula Rules in DSB, SB rules in DSS Up to 450cc 2-stroke water-cooled twins Up to 500cc 2-stroke air-cooled twins *The TZR250 is allowed in D Superbike only and must conform to Superstock rules with no limits on bodywork. The VF500 is allowed in D Superbike only with stock displacement. *There will be no bodywork or tire limitations in D Superstock. D Superstock bikes do not need to have DOT approval. FZR400’s may run 17” wheels. No matching UtahSBA class (but like twins GTU) Superstock SV, for example E SUPERSTOCK EXPERT & NOVICE 200-250cc 4-stroke air and water-cooled twins 200-250cc 4-stroke air and water-cooled singles *No bodywork restrictions. *No engine modifications allowed *All bikes may upgrade to 17” wheels so long as they do not weigh less than the stock wheels for that model. *Kickstand mounts may be cut off of frame. No matching UtahSBA class, but like Moto3 without the two-strokes LIGHTWEIGHT TWINS SUPERBIKE EXPERT & NOVICE and LIGHTWEIGHT TWINS SUPERSTOCK EXPERT & NOVICE Up to 800cc air-cooled twins Up to 750cc water-cooled twins with 3 valves Up to 700cc water-cooled twins with more than 3 valves Unlimited singles based on Formula rules (Superbike only) -No 125cc GP machines, *Buell Firebolt and Lightning, Harley-Davidson XR1200 (AMA Spec class limits in SS & SB), Ducati 900SS and any model using the 1000DS or 1100DS engine are allowed under Superstock rules in LWTSB only. *There are no bodywork limits in LWT. UtahSBA Twins GTU

HEAVYWEIGHT TWINS SUPERBIKE EXPERT & NOVICE and HEAVYWEIGHT TWINS SUPERSTOCK EXPERT & NOVICE Unlimited displacement air-cooled, four stroke twins, (based on Formula rules in HWTSB) Unlimited displacement water-cooled, four stroke twins, (under 900cc based on Formula rules in HWTSB) Up to 700cc water cooled, four stroke triples Any machine legal for Lightweight Twins 125cc & 250cc GP Machines in Superbike Only *Up to 1050cc Triples based on Superstock rules will be allowed in HWT Superbike only.

*There are no bodywork limits in HWT. UtahSBA SuperTwins FORMULA 1 EXPERT & NOVICE Unlimited displacement machinery UtahSBA King of the Mountain GTO FORMULA 2 EXPERT & NOVICE Up to 396cc 2-stroke water-cooled twins Up to 500cc 2-stroke air-cooled twins and multis Up to700cc 4-stroke twins Up to 600cc 4-stroke air-cooled multis Up to 565cc 4-stroke water-cooled multis Unlimited singles All D Superbike and LWT (SS and SB) Machines (must retain orignal class legality) No matching UtahSBA class, but like TwinsGTU / TwinsGTO FORMULA 3 (no Expert/Novice differentiation) Up to 125cc 2-stroke Grand Prix machines Up to 250cc 4-stroke engines in GP chassis UtahSBA Moto3 CLUBMAN EXPERT & NOVICE (all below based on Formula rules except as noted) Unlimited displacement 2 & 4-stroke singles Up to 605cc 4-stroke water-cooled twins Up to 650cc 4-stroke air-cooled twins Up to 250cc 4-stroke water-cooled multis Up to 600cc 4-stroke air-cooled 2 valve per cylinder multis Up to 570cc 4-stroke air-cooled 4 valve per cylinder multis Up to 450cc 2-stroke air-cooled multis Up to 396cc 2-stroke water-cooled multis All Vintage 3 & 4 machines *Honda Hawks and Air cooled Ducati 750’s, 250cc 2-stroke GP replica machines (TZR, NSR, RGV, etc..), Aprilia Cup, and Triumph Thruxton, are allowed but limited to Superstock mods., no Ducati Supermono. 125cc & 250cc GP machines are not allowed. No matching UtahSBA class. Big Supermoto bikes, EX500s, etc HEAVYWEIGHT SENIOR SUPERBIKE EXPERT & NOVICE Up to B Superbike and A Superbike machinery. All riders must be 40 years old or greater UtahSBA Formula 40 MEDIUMWEIGHT SENIOR SUPERBIKE EXPERT & NOVICE Up to C Superbike machinery. All riders must be 40 years old or greater No matching UtahSBA class, but like Formula 40 for middleweight bikes WOMENS SUPERSTOCK EXPERT & NOVICE Up to B Superbike and A Superstock machinery. All riders must be female UtahSBA Women's class SOLO CLASSES: Not running because of full endurance Heavyweight Expert & Novice - A & B Superstock, A & B Superbike, and Formula 1 machines Mediumweight Expert & Novice - C Superstock, C Superbike, and Formula 2 machines Lightweight Expert & Novice - 125 Grand Prix, Clubman, Lightweight Twins and D class machines. 8. The WERA NATIONAL CHALLENGE SERIES competition classes are as follows: WERA Superbike (Expert) Unlimited displacement machines FORMULA 2 (Expert & Novice) Machine Limits per Sportsman Formula 2 125 GRAND PRIX (no Expert/Novice differentiation) Up to 125cc 2-stroke Grand Prix machines Up to 250cc 4-stroke engines in GP chassis 1100cc, 750cc, & 600cc SUPERSTOCK (Expert & Novice) Machine limits per A, B, & C Superstock respectively

750cc, & 600cc SUPERBIKE (Expert & Novice) Machine limits as per B, & C Superbike respectively LIGHTWEIGHT TWINS SUPERSTOCK (Expert & Novice) Machine limits per Sportsman Lightweight Twins Superstock WOMENS SUPERSTOCK EXPERT & NOVICE Up to B Superbike and A Superstock machinery. All riders must be female