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Sunday, May 26, 2002 -- South Charleston, WV The WV Mountain Bike State Championship (Race the Trace) (iPO Event Id#: 4781)
NAME(Last)_____________________,(First)___________________
STREET____________________________________________________
CITY_______________________________STATE_____ZIP__________
DATE OF BIRTH_______________ MALE_______ FEMALE_______
T-SHIRT SIZE _______________
NUMBER OF GUEST ATTENDING BAR-B-QUE_______ (Total number
including yourself. Registration price includes rider and
one guest. Additional guest after one are $5.00 per person
maximum 2 additional)
Race Class
PRO/EXPERT ___ SPORT ___
VETERAN EXPERT(35+) ___ VETERAN SPORT(35+) ___
JR EXPERT(18-UNDER) ___ MASTERS(45+) ___
JUNIOR SPORT(15-18) ___
JUNIOR (14-UNDER) ___ CLYDEDALES(200lbs+) ___
BEGINNER ___
RELEASE AND CONSENT:
In consideration of the acceptance of my application and in signing
this 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 agree and will hold harmless the Race the Trace
committee, land owners, its sponsors and its volunteers respectively,
singularly and collectively 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 _____________________________________________________ PARENT/GUARDIAN IF UNDER 18 YRS OLD DATEWVMBA Members: $30.00 -- non WVMBA Members: $35.00 Make checks payable to, and mail to:
c/o P. McDonald 2720 Daniels Ave South Charleston, WV 25303 |
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