|
|---|
USA #:Rim Nordic Racing Card #.
|
LAST NAME:
FIRST NAME:
M.I.:
|
|
|
FAX ENTRIES PAID BY CREDIT CARD ONLY
|
||||
| PRO & CAT 1 | CAT 2 | CAT 3 | ||
Pro Men (H) Men 50 -54 (I) Men 55 +
(JJ) Jr. Wm 12-18 |
(J) Jr. Men 18 & under (S) 60+
(AA) Sp. Jr. Wm 18 & under
(VV) Women 40-49
|
(aa) Women 14 & Under (1 lap) |
||
Registration ($35 ....jr. $25)
Season Race Pass (4 Race Series) ($120) Season Pass with Stage Race ($160)
|
$
$ $
$
|
| No USA Cycling License Fee - $5.00 (Per Race) | $ |
| Mail Race Results - $1.00 | $ |
| TOTAL | $ |
Check or Money Order Visa Mastercard
|
|
MAIL or FAX to:
|
In consideration of this entry, I hereby for myself, my executors, administrators and assignees waive any and all right of claims for damages I may have against Rim Nordic Ski Area, Inc., all sponsors and individuals associated with said event for any and all injuries sustained by me in this event. Also, none of the above are responsible for the loss of personal items not any other form of aggravation in connection with the said event. I attest and verify that I am physically fit and have trained for this event. In signing this form, I acknowledge I have read and full understand my own liability and do accept the restrictions.Signature (If minor, Parent must sign)__________________________________________Date Signed_______________________ |