Last Name First Name Age on Sex
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race day M/F
Mailing address (include apt. # and c/o)
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| 50K______10K_____
City and State Zip/Postal Code
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Birth date Area Code Telephone
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Mo Day Yr
Shirt Size Small |__| Medium |__| Large |__| X Large |__|
E-Mail Address
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WAIVER. In consideration of acceptance of entry, for myself, executors, administrators and assignees do hereby release andf discharge Vacation Sports and all sponsors and associates from claims of damages, actions whatsoever, in any manner arising or growing out of my participation in said event. Knowingly and at my own risk I do hereby apply to enter an athletic
contest. Further, I hereby grant full permission to any and all of the foregoing to use my name, likeness and voice, as well as any photographs, videotape, motion pictures, recordings and any other
record of this event in which I may appear for any legitimate purpose including broadcast of the event, the reuse in any media of this broadcast and in advertising and promotion. I attest and verify that I have full knowledge of the risks involved in the event and I am physically fit and sufficiently trained to participate in the event.
Signature (by parent or guardian if participant is under 18) ___________________________________________________
MAIL ENTRY FORM - Chippewa Moraine 50K
Vacation Sports 5906 Highway 61 White Bear Lake, MN 55110
Make check payable to Vacation Sports