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18 HOURS OF FRUITA REGISTRATION FORM Complete the entry form and mail with your check (made payable to Event Marketing Group LLC) to: 18 Hrs of Fruita To register online, go to www.active.com. TEAM NAME(mandatory) ___________________________________ Please check your team category Solo Male____Female_____ 2-Person Male____Female_____Coed_____ 4-Person Male____Female_____Coed_____ 6-8 Person Coed_____ Team Captain (mandatory-solo, 2-person, 4-person, 6-8 person) Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (2-person, 4-person, 6-8 person) Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (4-person, 6 person-8) ___________________________________ Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (4-person, 6-8 person) ___________________________________ Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (6-8 person) Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (6-8 person) ___________________________________ Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (6-8 person) Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10) Team Mate (6-8 person) Mailing address____________________________ City_______________________________ State_____Zip______ Day Phone___________________________ Night Phone__________________________ E Mail (mandatory)_______________________ Sex_______Age_______(as of 5/7/10)
TOTAL ENCLOSED$_______ $25 charge will be assessed for returned checks Team Captain Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Team Mate Signature ______________________________Date__________ Parent or Guardian (if under 18 years of age) ______________________________Date__________
"All fees are non-refundable" TOTAL ENCLOSED$_______
Signature______________________________Date__________ Signature of Parent or Guardian if under 18 _______________Date______ Return completed form to: 18 Hrs of Fruita, c/o Event Marketing Group, 14128 Blue River Trail, Broomfield, CO 80023 Waiver -In consideration of my entry, I, intending to be legally bound for myself, my executors, administrator and assignees, do hereby waive and release the sponsors of this event and all persons and agencies connected with this event from all claims for damages, injuries or death, arising from my participation in and the travel to and from this event. I recognize that I may become injured or incapacitated in a location where it is difficult for management to get required medical aid to me in time to avoid physical injury or even death. I also certify that I am physically fit and adequately trained to participate in this event. I also understand and agree that a sponsor may subsequently use for publicity and/or promotional purposes my name and/or pictures of me participating in this event without obligation or liability to me. I also understand entry fees I pay are non-refundable. © 2010 Event Marketing Group LLC |
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