Red Flag Fund - Helping Injured Roadracers

What if You Need Help

If you or someone you know needs assistance from a serious injury sustained while participating in a sanctioned Road Racing event, please contact us with the following information:

Racer Information
Racer Name (First, Middle, Last):
Address:
City:
State:
Zip:
Telephone:
Email:
Fax:

Applicant Information if applicant is not intended recipient
Relationship to racer:
Name (First, Middle, Last):
Address:
City:
State:
Zip:
Telephone:
Email:
Fax:

Incident information
Date of incident:
Approximate time of incident:
Description of incident:
Others involved:
Race organization:
Competition number:
Status (Expert/Novice):
Track incident occurred on:
Description of injuries:
Description of treatment:
Current status of rider:
Does rider have health insurance?
Does rider have disability insurance?



	What if You Need Help If you or someone you know needs assistance from a serious injury sustained while participating in a sanctioned Road Racing event, please contact us with the following information: Racer Information Racer Name (First, Middle, Last): Address: City: State: Zip: Telephone: Email: Fax: Applicant Information if applicant is not intended recipient Relationship to racer: Name (First, Middle, Last): Address: City: State: Zip: Telephone: Email: Fax: Incident information Date of incident: Approximate time of incident: Description of incident: Others involved: Race organization: Competition number: Status (Expert/Novice): Track incident occurred on: Description of injuries: Description of treatment: Current status of rider: Does rider have health insurance? Does rider have disability insurance?