Saturday, June 12, 1999 - Sunday, June 13, 1999 -- Parkersburg
1999 Registration for Challenge at Mountwood
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NAME________________________________________________________
ADDRESS_____________________________________________________
CITY_________________________________STATE_____ZIP__________
PHONE#______________________________________________________
AGE_____________ MALE____________ FEMALE____________
CLASS: CROSS COUNTRY DOWNHILL 18 & UNDER
(40K, Three 8
mile loops)
PRO/EXPERT _____________ ________ __________
JR EXPERT
(18 & UNDER) _____________ ________ __________
VETERAN
(35 - 44) _____________ ________ __________
28K Two 8
mile loops
JUNIOR/
SPORT
(14 & UNDER) ______________ _________ __________
SPORT ______________ _________ __________
VETERANS/
SPORT
(35 - 44) ______________ _________ __________
MASTERS ______________ _________ __________
CLYDEDALES _____________ _________ __________
12K,One 8
mile loop
BEGINNER ______________ _________ __________
KIDS CHALLENGE
CLASS:
12 & UNDER _______________
10 & UNDER _______________
8 & UNDER _______________
RELEASE AND CONSENT: In consideration of the acceptance of my application and in signing the release and consent for myself or for the named entrant (if the entrant is under the age of 18), I acknowledge that I understand the intent hereof, that I hereby agee and will hold harmless the Challenge At Mountwood Committee and WCPRC, it's individual members, it's officers, and it's support entities, respectively; singularly and collectively, from and against any blame of liability for any injury, misadventure, harm, loss, inconvenience or damages suffered or asscociated therewith. I also hereby consent to and permit emergency treatment in the event of injury or illness. I shall abide by traffic laws and regulations and practice courtesy and safety in cycling. Helmets are required for all races.
_________________________________________________________________ SIGNATURE OF ENTRANT DATE _________________________________________________________________ SIGNATURE OF PARENT/GUARDIAN IF UNDER 18 YRS OLD DATE