Last Name: First Name: Gender: Male Female (circle) DOB: Age: Street: City: State: Zip: Phone: Alternate Phone: E-mail: Alternate E-mail: Emergency Contact: Relationship: Emergency Contact Phone Number:Waiver and Release Agreement • February 25th, 2021
Contract Type FiledFebruary 25th, 2021WAIVER OF PUBLICITY: I agree that images of me may be used in any legal manner without payment to me. I have read and understand all of this. I make this agreement and pay my entry fee in exchange for the privilege of participating under the race committee’s conditions.