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'THE GOLD RUSH’ SUMMER CHALLENGE Six Hour Adventure Race Official Entry Form 2009 |
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MAIL TO: Team Karma, 1521 De Ve
Ave , Modesto , CA
95350
Team
member 1: Team member 2:
Team
Name____________________________________________________
First Name ___________________ _________________
Last ___________________ _________________
E-mail _____________________ ___________________
Address _______________________ _________________________
City____________State____Zip_______ _____________ ___ _______
Age Race Day: _________ M__F__ Age: _____ M __ F __
Shirt size (S,M,L,XL,XXL) ______ _______
Home Phone _________________ _________________
Work Phone _________________ _________________
Emergency Contact ___________________ ______________________
Emergency Phone ___________________ ______________________
ENTRY FEE: Two person team
$140.oo $______ (Note:Race entry fee
($65.oo/person
, $50.oo under 25) does
NOT include boat.
Teams must supply canoe, kayak or
raft. Or call 'GoldRush AR' for help.
(Additional charge if more
than 4 persons)
POST-RACE MEAL:
Two team members and one crew
included in entry fee.
Additional persons, $5.oo/person $_______
LATE ENTRY: After
---------------
TOTAL FEE SUBMITTED $_______
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 Summer 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 ________
(parent
or guardian if applicant is under 18)
Signature team member 2 ___________________ Date ________
(parent
or guardian if applicant is under 18)
* Race packet and gear list will be mailed on receipt
of entry. *