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'THE GOLD RUSH’ 24 HOUR CHALLENGE Official Entry Form 2007 |
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MAIL TO: Team Karma, 1521 De Ve Ave , Modesto , CA 95350
Team Name:
__________________________________
MEMBERS:
1. First Name:
Last: E-mail:
Address: City: State:
Zip:
Age Race
Day: M
F Shirt Size:
(S,M,L,XL,XXL)
Home Phone:
Work
Phone: Emergency Contact: Emergency Phone:
2. First Name:
Last: E-mail:
Address: City: State:
Zip:
Age Race
Day: M
F Shirt Size:
(S,M,L,XL,XXL)
Home Phone:
Work
Phone: Emergency Contact: Emergency Phone:
3. First Name:
Last: E-mail:
Address: City: State:
Zip:
Age Race
Day: M
F Shirt
Size: (S,M,L,XL,XXL) Home Phone:
Work
Phone: Emergency Contact: Emergency Phone:
4. First Name:
Last: E-mail:
Address: City: State:
Zip:
Age Race
Day: M
F Shirt Size:
(S,M,L,XL,XXL)
Home Phone:
Work
Phone: Emergency Contact: Emergency Phone:
Awards for Masters Division (Combined
age 160+)
ENTRY FEE: $195.00/person, $145 under 25. (3 Person team $585, 4 person $780) $
POST-RACE MEAL: $
Four team members
and one crew included in entry fee.
Additional persons, $7.00/person)
LATE ENTRY: After
RACE IS LIMITED TO 25 TEAMS
TOTAL FEE SUBMITTED (checks payable to ‘
NOTE: Race entry fee does NOT include boat.
Teams must supply canoe, kayak or raft, or call Gold Rush Adventure
Races for help.
LIABILITY WAIVER: In consideration
for accepting my entry, I, intending to be legally bound, hereby for myself, my
heirs, executors and administrators, waive and release
any and all claims against persons and organizations affiliated with the race, Gold Rush 24 Hour Challenge,
while participating or traveling to or from the race. I further attest that I am physically fit for
this race and am able to swim.
Signature Team Member 1 Date:
Signature Team Member 2 Date:
Signature Team Member 3 Date:
Signature Team Member 4 Date:
(Parent or guardian MUST
sign if applicant is under 18)