REGISTRATION - Rubithon

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Step 1 of 10 - WELCOME

Welcome to the 2023 Rubithon Registration!

Rubithon is the annual, official event of the Toyota Land Cruiser Association and we are glad you want to join us this year!

This year’s Rubithon is dedicated in memory of Marlin Czajkowski. The event shirt will honor Marlin, and a portion of the proceeds will be donated to Marlin’s family.

I Am Participating In Rubithon As*

Not sure? Then you are probably a participant. Committee and Lead positions require pre-approval and a password provided by the Rubithon Chairman.

A Participant

A Committee Member

A Lead Member

Committee Position*

Lead Position*

Committee Password*

Please enter the password provided to your by the Rubithon Chair for this position to continue to the next screen.

Lead Password*

Please enter the password provided to your by the Rubithon Chair for this position to continue to the next screen.

Please Select Your Desired Registration Option*

Basic Registration $150 (Includes up to 3 nights of Camping at Rubicon Springs, Dash Plaque, goody bag and one Grand Prize Driver Raffle Ticket)
Wheel Deal Registration $200 (Includes Basic Registration plus 2 dinners and 2 event T-shirts*) – Save $25
Premier Registration $235 (Includes above plus TLCA First Class Membership (new or renewal) and an extra Grand Prize Driver Raffle Ticket) – Save $40

*Note – there is an additional cost of $5 for each 2XL item and $7.50 for each 3XL or 4XL item

Basic Registration

Wheel Deal Registration

Premier Registration

Please Select Your Desired Registration Option*

Committee Registration $75 (Includes up to 3 nights of Camping at Rubicon Springs, 1 dinner, 1 event T-Shirt, Dash Plaque, goody Bag and one Grand Prize Driver Raffle Ticket)

Committee Premier Registration $140 (Includes Committee Registration and TLCA First Class Membership (new or renewal), a 2nd dinner, 2nd event T-Shirt and an Extra Grand Prize Driver Raffle Ticket)

Committee Registration

Committee Premier Registration

Please Select Your Desired Registration Option*

Lead Registration FREE! Thank You for being a LEADER! (Includes up to 3 nights of Camping at Rubicon Springs, 1 dinner, 1 event T-Shirt, Dash Plaque, goody Bag and one Grand Prize Driver Raffle Ticket)

Lead Premier Registration $65 (Includes Committee Registration and TLCA First Class Membership (new or renewal), a 2nd dinner, 2nd event T-Shirt and an Extra Grand Prize Driver Raffle Ticket)

Lead Registration

Lead Premier Registration

Dinner Selection*
Please Choose Included Saturday Dinner (you will have the opportunity to order extra later if needed)

Dinner Selection #2*
Please Choose Included Saturday Dinner (you will have the opportunity to order extra later if needed)

T-shirt Selection*
Please Choose Included T-shirt (you will have the opportunity to order extra later if needed) 2X +$2.50, 3X - 4X +$5.00

T-shirt Selection*
Please Choose Included T-shirt (you will have the opportunity to order extra later if needed)

T-shirt Selection #2*
Please Choose Included T-shirt (you will have the opportunity to order extra later if needed) 2X +$2.50, 3X - 4X +$5.00

T-shirt Selection #2*
Please Choose Included T-shirt (you will have the opportunity to order extra later if needed)

Additional Red Kap Mechanic Shirt (Optional)
S – XL: $35, 2XL: $37.5, 3XL: $40

Hidden

I acknowledge the $25 late fee after June 30th

Late Fee

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Rubithon is a Sanctioned TLCA event and therefore you are required to have a current TLCA membership in order to participate. Your TLCA Membership must be current through September 2023 in order to participate. Not a current TLCA member? Don't worry, we can help you purchase or renew your membership with this registration.
Your Premier Registration includes a TLCA 1st Class Membership (new or renewal). Are you a current TLCA Member?*

Yes

No
Are you a current TLCA Member?*

Yes

No
I'd like to renew my current TLCA membership with my Rubithon registration.*

Yes

No
Enter Your TLCA ID NUMBER*
Find your member number at tlca.org/my-account or call 800-655-3810 for assistance.

TLCA Membership Expiration Month*
Your membership must be current through June 2023 unless it is set to automatically renew before then.
TLCA Membership Expiration Year*
Please select a TLCA Membership*

First Class Membership $45

General Membership $35

Online Only Membership $25
Thanks for joining TLCA! We will assign you a TLCA ID# and send out a membership email 1 -2 business days after we receive your registration payment.
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Please Select One Run*
Must arrive a minimum 1 hour before listed departure time.

Wednesday Barker’s Pass Run

Wednesday Solid Axle Run

Thursday Huft’s Breakfast Run

Family Run from Tahoma

Restricted (Pre-Qualified or Invite Only Run)

Renegade Run (plan your own)
Please enter pre-qualified run code/permission information provided to you*

Which Pre-Qualified Run*

Mudrak’s Double Rocker Run

Marlin Crawler Sweeper Run
Number of Breakfasts Needed Quantity
optional

Price: $17.50

Please List Departure Date*
MM slash DD slash YYYY

Please list your departure location*

Loon Lake

Tahoma Staging

Wentworth Springs
Please list your leader or club*

Please provide the names of everyone in your vehicle including the driver*
First Name
Last Name
Is this a driver or passenger?

Are any of your passengers under the age of 18?*

yes

no
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT*
IN CONSIDERATION of being permitted to compete, officiate, observe, work, or participate in any way in the EVENT(S) or being permitted to enter for any purpose any RESTRICTED AREA (defined as any area requiring special authorization, credentials, or permission to enter or any area to which admission by the general public is restricted or prohibited), EACH OF THE UNDERSIGNED, for himself, his personal representatives, heirs, and next of kin:

1. Acknowledges, agrees, and represents that he has or will immediately upon entering any of such RESTRICTED AREAS, and will continuously thereafter, inspect the RESTRICTED AREAS which he enters, and he further agrees and warrants that, if at any time, he is in or about RESTRICTED AREAS and he feels anything to be unsafe, he will immediately advise the officials of such and if necessary will leave the RESTRICTED AREAS and/or refuse to participate further in the EVENT(S).

2. HEREBY RELEASES,WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, competition vehicle owners, drivers, pit crews, rescue personnel, any persons in any RESTRICTED AREA, promoters, sponsors, advertisers, owners and leassees of premises used to conduct the EVENT(S), premises and event inspectors, surveyors, underwriters, consultants and others who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities regarding the premises or EVENT(S) and each of them, their directors, officers, agents and employees, all for the purposes herein referred to as "Releasees," FROM ALL LIABILITY TO THE UNDERSIGNED, his personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OF OR RELATED TO THE EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them FROM ANY LOSS, LIABILITY, DAMAGE, OR COST they may incur arising out of or related to the UNDERSIGNED’S INJURY OR DEATH, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

4. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to the EVENT(S) whether caused by the NEGLIGENCE OF RELEASEES or otherwise.

5. HEREBY acknowledges that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED, also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.

6. HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Releasees, INCLUDING NEGLIGENT RESCUE OPERATIONS and is intended to be as broad and inclusive as is permitted by the laws of the State or Province in which the Event(s) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
SIGNATURE*

PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT*
IN CONSIDERATION of my minor child (“the Minor”) being permitted to participate in any way in the EVENT(S) and/or being permitted to enter for any purpose any RESTRICTED AREA(S) (defined to be any area which requires special authorization, credentials or permission to enter or any area to which admission by the general public is restricted or prohibited), I agree:

1. I know the nature of the EVENT(S) and the Minor’s experience and capabilities, and believe the Minor to be qualified to participate in the Event(s). I will inspect the premises, facilities, and equipment to be used, or with which the Minor may come in contact. IF I OR THE MINOR BELIEVE ANYTHING IS UNSAFE, I WILL INSTRUCT THE MINOR TO IMMEDIATELY LEAVE THE RESTRICTED AREA AND REFUSE TO PARTICIPATE FURTHER IN THE EVENT(S).

2. I FULLY UNDERSTAND and will instruct the Minor that: (a) THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and participation in the Event(s) and/or entry into Restricted Areas involves RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH (“RISKS”); (b) these Risks and dangers may be caused by the Minor’s own actions, or inactions, the actions or inactions of others participating in the Event(s), the rules of the Event(s), the condition and layout of the premises and equipment, and/or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW; (c) there may be OTHER RISKS NOT KNOWN TO ME or that are not readily foreseeable at this time; (d) THE SOCIAL AND ECONOMIC LOSSES and/or damages that could result from those Risk(s) COULD BE SEVERE AND COULD PERMANENTLY CHANGE THE MINOR’S FUTURE.

3. I consent to the Minor’s participation in the Event(s) and/or entry into restricted areas and HEREBY ACCEPT AND ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, AND ASSUME ALL RESPONSIBILITY FOR THE LOSSES, COSTS AND/OR DAMAGES FOLLOWING SUCH INJURY, DISABILITY, PARALYSIS OR DEATH, EVEN IF CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW.

4. I HEREBY RELEASE, DISCHARGE AND COVENANT NOT TO SUE the promoters, participants, racing associations, sanctioning organizations or any subdivision thereof, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel,
any persons in any Restricted Area, sponsors, advertisers, owners and lessees of premises used to conduct the Event(s), premises or event inspectors, surveyors, underwriters, consultants and other persons or entities who give recommendations, directions, or instructions or engage in risk evaluation or loss control activities regarding the premises or Event(s) and each of them, their directors, officers, agents, employees, representatives, owners, members, affiliates, successors and assigns, all for the purposes herein referred to as “Releasees,” FROM ALL LIABILITY TO ME, THE MINOR, my and the minor’s personal representatives, assigns, heirs, and next of kin, FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON ACCOUNT OF ANY INJURY TO ME OR THE MINOR, including, but not limited to, death or damage to property, CAUSED OR ALLEGED TO BE CAUSED, IN WHOLE OR IN PART, BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE.

5. If, despite this release, I, the Minor, or anyone on the Minor’s behalf, makes a claim against any of the “Releasees” named above, I AGREE TO DEFEND, INDEMNIFY AND SAVE AND HOLD HARMLESS THE RELEASEES and each of them from ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS, LIABILITY, DAMAGE, OR COST THEY MAY INCUR DUE TO THE CLAIM MADE AGAINST ANY OF THE “RELEASEES” NAMED ABOVE, WHETHER THE CLAIM IS BASED ON THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

6. I sign this agreement on my own behalf and on behalf of the Minor.

I HAVE READ THIS PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, UNDERSTAND THAT BY SIGNING IT I GIVE UP SUBSTANTIAL RIGHTS I AND/OR THE MINOR WOULD OTHERWISE HAVE TO RECOVER DAMAGES FOR LOSSES OCCASIONED BY THE RELEASEES’ FAULT, AND SIGN IT VOLUNTARILY AND WITHOUT INDUCEMENT.
SIGNATURE OF PARENT OR GUARDIAN*

MINOR’S ASSUMPTION OF RISK AND RELEASE AND WAIVER OF LIABILITY*
I have obtained my parent’s consent to participate in the above event(s). I understand that I am assuming all of the risks if I get hurt during the event(s), and I state the following:

1. Both my parents and I believe I am qualified to participate in the event(s). I will inspect the premises and equipment and if, at any time, I feel anything to be unsafe, I will immediately leave and refuse to participate further in the event(s).

2. I understand that the ACTIVITIES OF THE EVENT ARE VERY DANGEROUS and INVOLVE RISKS AND DANGERS OF MY BEING SERIOUSLY INJURED OR HURT, MY BEING PARALYZED OR KILLED.

3. I know that these risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the event(s), the rules of the event(s), the condition and layout of the premises and equipment, and/or the NEGLIGENCE of others, including those persons responsible for conducting the event(s).

4. I HEREBY ASSUME ALL SUCH RISKS, EVEN IF THE RISKS ARE CREATED BY THE NEGLIGENCE of the promoters, participants, racing associations, sanctioning organizations, or any of its subdivisions, track operators, track owners, officials, car owners, drivers, pit crews, rescue personnel, any persons in any restricted areas, promoters, sponsors, advertisers, owners, and lessees of premises used to conduct the events, premises or event inspectors, surveyors, underwriters, consultants, and any other person or entity who gives recommendations, directions, or instructions, or engages in risk evaluation, loss control activities or sales regarding the premises or events, and each of them, their directors, officers, agents, employees, representatives, owners, members, affiliates, successors and assigns, all for the purposes herein referred to as “Releasees.”

5. I HEREBY RELEASE, WAIVE, COVENANT NOT TO SUE, AND DISCHARGE, ALL OF THE RELEASEES FROM ALL LIABILITY TO ME, my personal representatives, assigns, heirs, and next of kin, for any and all loss or damage and any claim or any demand on account of any injury to me including, but not limited to, my death, whether caused by the NEGLIGENCE of the Releasees or otherwise.

I HAVE READ THE ABOVE ASSUMPTION OF RISK AND RELEASE AND WAIVER OF LIABILITY, UNDERSTAND WHAT I HAVE READ, AND SIGN IT VOLUNTARILY.
SIGNATURE OF MINOR PARTICIPANT*

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EXTRA SATURDAY DINNERS
*You have selected the basic registration which does not include dinner so you might consider purchasing a dinner.
*Your registration selection comes with 1 dinner so you only need this option if you require more than 1 dinner.
*Your registration selection comes with 2 dinners so you only need this option if you require more than 2 dinners.
Beef Dinner Quantity

Price: $17.50

Beef Dinner Quantity

Price: $12.50

Chicken Dinner Quantity

Price: $17.50

Chicken Dinner Quantity

Price: $12.50

T-SHIRTS
This year’s event shirt will honor Marlin Czajkowski, and a portion of the proceeds will be donated to his family. Please include any extra shirts in your registration so that we have enough for all that want them.
*You have already selected 2 t-shirts with your registration. This option is if you would like extra(s).
*You have already selected 1 t-shirt with your registration. This option is if you would like extra(s).
Men's Small T-Shirt Quantity

Price: $25.00

Men's Small T-Shirt Quantity

Price: $20.00

Men's Medium T-Shirt Quantity

Price: $25.00

Men's Medium T-Shirt Quantity

Price: $20.00

Men's Large T-Shirt Quantity

Price: $25.00

Men's Large T-Shirt Quantity

Price: $20.00

Men's XL T-Shirt Quantity

Price: $25.00

Men's XL T-Shirt Quantity

Price: $20.00

Men's 2X T-Shirt Quantity

Price: $30.00

Men's 2X T-Shirt Quantity

Price: $25.00

Men's 3X T-Shirt Quantity

Price: $32.50

Men's 3X T-Shirt Quantity

Price: $27.50

Men's 4X T-Shirt Quantity

Price: $32.50

Men's 4X T-Shirt Quantity

Price: $27.50

Women's Small T-Shirt Quantity

Price: $25.00

Women's Small T-Shirt Quantity

Price: $20.00

Women's Medium T-Shirt Quantity

Price: $25.00

Women's Medium T-Shirt Quantity

Price: $20.00

Women's Large T-Shirt Quantity

Price: $25.00

Women's Large T-Shirt Quantity

Price: $20.00

Women's XL T-Shirt Quantity

Price: $25.00

Women's XL T-Shirt Quantity

Price: $20.00

Women's 2X T-Shirt Quantity

Price: $30.00

Women's 2X T-Shirt Quantity

Price: $25.00

Women's 3X T-Shirt Quantity

Price: $32.50

Women's 3X T-Shirt Quantity

Price: $27.50

Women's 4X T-Shirt Quantity

Price: $32.50

Women's 4X T-Shirt Quantity

Price: $27.50

Child Small Quantity

Price: $25.00

Child Small Quantity

Price: $20.00

Child Medium Quantity

Price: $25.00

Child Medium Quantity

Price: $20.00

Child Large Quantity

Price: $25.00

Child Large Quantity

Price: $20.00

RUBITHON HOODIES
Small Hoodie Quantity

Price: $40.00

Small Hoodie Quantity

Price: $35.00

Medium Hoodie Quantity

Price: $40.00

Medium Hoodie Quantity

Price: $35.00

Large Hoodie Quantity

Price: $40.00

Large Hoodie Quantity

Price: $35.00

XL Hoodie Quantity

Price: $40.00

XL Hoodie Quantity

Price: $35.00

2X Hoodie Quantity

Price: $45.00

2X Hoodie Quantity

Price: $40.00

3X Hoodie Quantity

Price: $47.50

3X Hoodie Quantity

Price: $42.50

4X Hoodie Quantity

Price: $47.50

4X Hoodie Quantity

Price: $42.50

Air Medcare Network
Rubithon attempts to provide air ambulance coverage as a courtesy for all participants of the event. This requires us to collect information on every passenger. Please note that passengers not listed by you will not be covered under the policy. Please also note that in certain instances depending on the air ambulance company that is available at the time, you may not be covered under our courtesy insurance. For this reason we recommend that ALL participants get their own individual insurance policy from Care Flight to ensure 100% coverage.
Please list the number of passengers in your vehicle (not including the driver)*
Passenger 1 Name*
First Last
Passenger 1 Address*
Same As Driver

Street Address Address Line 2 City State ZIP Code

Passenger 1 Phone*
Passenger 2 Name*
First Last
Passenger 2 Address*
Same As Driver

Street Address Address Line 2 City State ZIP Code

Passenger 2 Phone*
Passenger 3 Name*
First Last
Passenger 3 Address*
Same As Driver

Street Address Address Line 2 City State ZIP Code

Passenger 3 Phone*
Passenger 4 Name*
First Last
Passenger 4 Address*
Same As Driver

Street Address Address Line 2 City State ZIP Code

Passenger 4 Phone*
Passenger 5 Name*
First Last
Passenger 5 Address*
Same As Driver

Street Address Address Line 2 City State ZIP Code

Passenger 5 Phone*
Passenger 6 Name*
First Last
Passenger 6 Address*
Same As Driver

Street Address Address Line 2 City State ZIP Code

Passenger 6 Phone*
Do you or any of your passengers have their own individual Air Medcare Network policy?*

Yes

No
List the participant names covered under your individual Air Medcare Network policy.*

I understand that Rubithon attempts to provide air ambulance coverage as a courtesy but that 100% coverage is not guaranteed. In order to guarantee 100% coverage it is recommended that I obtain my own individual policy from Care Flight.*

I have read and understand the air ambulance terms

Please confirm that all of your registration information below is correct. You may use the previous buttons at the bottom of the page to make changes as needed. {all_fields}

Comments, Questions, Things We Need To Know
Coupon

Total

Payment Method*

Credit Card

PayPal

Check
Credit Card*
Card Details
Cardholder Name
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code Country

Click on "complete registration" and you will be taken to PayPal to complete your payment. Your registration is not confirmed until payment is completed.
Check Number*
Your registration is not confirmed until payment is received

Welcome to the 2023 Rubithon Registration!

EXTRA SATURDAY DINNERS

T-SHIRTS

RUBITHON HOODIES

Air Medcare Network

Departing Wednesday, September 6

Departing Thursday, September 7

Restricted Registration Runs

Departing Wednesday, September 6

Departing Friday, September 8