Pusheta Creek MX Membership Form

Thank you for your interest in riding at Pusheta Creek MX Park. Please provide the following information. Completion of the following form will generate a new or update your current membership information and is required before you can ride at Pusheta Creek MX Park. Remember that membership at Pusheta Creek MX Park is required but is free of charge.

Following submission of this form you will receive an email with your membership number. A new waiver must be completed for each year before you will be allowed to ride and you membership number is needed to complete the waiver.

Thank you, and we look forward to seeing you at Pusheta Creek MX Park!

Membership Number

If you have a Pusheta Creek MX membership number from a previous year and know what that number is, enter it here. If you are a new member or do not remember your number, leave this field blank.

First name*

Last name*

Phone number*

Street address*

City*

State/Region*

Zip Code*

Email*

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Relationship*

Additional Family Members

Please list any minor family members that should be included in this membership. All riders 18 years and older should have their own separate membership.