The Gold Rush Summer Challenge

THE GOLD RUSH SUMMER CHALLENGE Six-Hour Adventure Race 2011 Official Entry Form

MAIL TO: GoldRush AR, 1521 De Ve Ave, Modesto, CA 95350. (209)-575-3041 Team member 1: Team member 2: Team Name:______First Name ______Last ______E-mail ______Address ______City______State____Zip______Age Race Day: ______M__F__ Age: _____ M __ F __ Shirt size (S,M,L,XL,XXL) ______Home Phone ______Work Phone ______Emergency Contact ______Emergency Phone ______

ENTRY FEE: Two person team $140.oo $______(Note:Race entry fee ($70.oo/person , $50.oo under 25) does NOT include boat. Teams must supply canoe, kayak or raft.or call ‘GoldRush AR’ for help.)

CAMP SITE Fri.& Sat: Per Team $20.00 $______(Additional charge if more than 4 persons)

POST-RACE MEAL: Two team members and one crew included in entry fee. Additional persons, $5.oo/person $______

LATE ENTRY: After May 15th, 2011, $20.00 per Team $______------TOTAL FEE SUBMITTED $______

LIABILITY WAIVER: In consideration for accepting my entry I, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all claims against persons and organizations affiliated with the race, Gold Rush Summer Challenge, while participating or traveling to or from the race. I further attest that I am physically fit for this race and am able to swim.

Signature team member 1 ______Date ______(parent or guardian if applicant is under 18) Signature team member 2 ______Date ______(parent or guardian if applicant is under 18)

* Race packet and gear list will be mailed on receipt of entry. *