(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)




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