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2008 Burlington C1-Pursuit Race Entry Form

Saturday - April 19, 2008
Start Time - 11:00 a.m. (CST)        Race Meeting - 10:20 a.m. (CST)

Long sleeve, mock turtleneck t-shirts to first 48 competitors registered by April 12, 2008.

Entry Fee $26.00: Must be received by April 12, 2008.

No race day entry for Seeded Class! All late entries will go into the Open Class.

Late (after April 12) and Race Day Entry Fee $36.00: (may register up to 9:30 a.m. race day)
 


Make checks payable to:
    Burlington C1 Pursuit Race

Mail your completed entry form to:
    Fritz Hansen / C1 Pursuit
    N5152 Clausen Road
    Burlington, WI  53105

Name:
________________________________________________  Age:_______
Street  Address:
________________________________________________


________________________________________________

City:
________________________________________________

State:
______________________		 Zip  Code:
___________________

Telephone:
(______)______________
Email:
_________________________________
Circle One:      Open         Seeded
T-shirt Size:
Medium ______     Large ______     X-Large _______
 
     
WAIVER OF LIABILITY:

In consideration for your accepting this entry,  I the undersigned, intending to be legally bound, hereby, for myself, my heirs, executors and administrators, wave and release any and all rights and claims for damages to equipment or personal injuries suffered by me in the 2008 Burlington C-1 Pursuit Race, that I may have against the USCA, WCRA, City of Burlington, race organizers, race sponsors and landowners whose lands border the Fox River race course.
I attest and verify that I am physically fit and have sufficiently trained for the competition of the event and a licensed Medical Doctor has verified my physical condition.  Entrants under 18 years must have a waiver signed by themselves and parent or guardian. 

Signature of Entrant:
_______________________________________
Signature of Parent or Guardian  for Entrants Under 18:
_______________________________________

Date:
_______________________________________

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