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Name
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Address
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City, State, Zip
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Day Phone
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Evening Phone
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Email Address
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Age on 6/13/2009
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Sex:
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FEMALE MALE
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Select Event
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___ Duathlon: 8:00 AM ___ Relay Team: 8:00 AM
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Relay Team Name:
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Age Divisions
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16-19; 20-29;
30-39; 40-49; 50-59; 60 +
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Circle Shirt Size
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T-Shirt: Small Medium Large X Large
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I hereby signify that I understand that TARK, the Village
of Deforest, the Norski Duathlon sponsors, the area where I run and bike and all
other organizations and person connected with this event are not to be held responsible
for any injuries which I may suffer while taking part in this event or as as a result
thereof. In this connection, I hereby waive any claim for damages to my person or
property. I further state that I am in proper physical condition to participate
in this event. I grant permission for the organizers to use any photograph of any
record of this event for any legitimate purpose.
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Participant's signature
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Date
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Guardian's signature, if participant is under 18
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Date
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