ENTRY FORM

(fill out one form for EACH team member)

(and as always, please print legibly)

 

NAME ______________________________

 

CATEGORY __________________________

 

TEAM NAME _________________________

 

STREET ADDRESS ____________________

 

CITY, STATE, ZIP ____________________

 

PHONE _____________________________

 

EMAIL ______________________________

(for notification of future events, names will not be sold)

 

SEX:MALE/FEMALE

 

Hold Harmless: In consideration of the acceptance of this entry,I hereby, for myself, my executors, administrators, and assigns, do release and discharge Triangle Cyclopaths,Devilís Ridge Motocross Park,†† the county of Sanford, the sponsors, and all race personnel from any claims for damage suffered by me as a result of my participation in or traveling to or from said events held on

November 5, 2005. I further certify that I am in proper physical condition to participate in this event, and accept full responsibility for my own safety during the event.

 

___________________________________________

Signature of Participant††††††††††††††††††††††††††††† Date

 

 

__________________________________________

Signature of Guardian if Under age 18 †††† Date

 

Emergency Contact Information

 

Contact:______________________________

Phone:________________________________