Info: www.navraces.com, 206-291-8250
2014 Cleman Mountain Entry Form – 1 form per person Cleman Mountain Nav Race c/o MerGeo Please print, fill out and mail this form by the entry deadline listed below. 7400 Sand Point Way NE, Mail the form and a check for the appropriate amount made out to "MerGeo", Suite 201N to the address at right. Participants from outside the U.S. may send their Seattle, WA 98115 entry information by the deadline and pay cash at check-in on event day.
Your name______Your sex: M / F (please circle)
Your date of birth (optional if you are in the open age category)______City, country______
Contact e-mail______Phone______□ do not e-mail me about upcoming navigation races. (Note: We do not share your personal information with other organizations.)
Emergency contact name and phone #______
Team Name______Number of Team Members______
Names of Team Members______
______
Team Age Category (circle one): open avg. 45+ avg. 60+ all 13-21 team has youth 12/under
Is this your first wilderness nav event? Yes / No How did you hear about Cleman?______
Mail-in fees are per person according to age (age 22+, then age 13-21, then 12/under), and 7.9% sales tax is included. : 9/27 Race, Training (circle) Early entry, by 8/12 Regular entry, by 9/16 Under-the-wire, by 9/24* Your Fee Classic Race & Compass $29, $19 13-21, $13 12/und $34, $19 13-21, $13 12/und $39, $23 13-21, $17 12/und Course Classic Race only $23, $15 13-21, $11 12/und $27, $15 13-21, $11 12/und $31, $19 13-21, $15 12/und Compass Course only $9, $6 13-21, $5 12/und $11, $6 13-21, $5 12/und $13, $8 13-21, $6 12/und
9/28 Race (please circle) Early entry, by 8/12 Regular entry, by 9/16 Under-the-wire, by 9/24 Your Fee 4-Hour, start: 9:00a / 12:30p $44, $34 13-21, $22 12/und $48, $34 13-21, $22 12/und $54, $39 13-21, $26 12/und 8-Hour $65, $46 13-21, $33 12/und $69, $46 13-21, $33 12/und $76, $51 13-21, $38 12/und
* See www.navraces.com for event-day entry fee information. Total entry fees: ______Discounts on 9/28 race entry fee: Adults 22+ on a team with at least T-shirt(s): + ______one child 12 or under may deduct $10. Orienteering club or WTA members may deduct $5. Search & Rescue or first-responder Discount: - ______personnel may deduct $10. Discounts may not be combined.
Total fees: ______Cotton T-shirts (indicate number of each size) $18 per T-shirt (pre-order only.)
Unisex sizes: S__ M__ L__ XL__ XXL__
Liability Waiver & Photo Release
I know that nav racing (rogaining) is potentially dangerous. The dangers include but are not limited to falling or colliding; medical conditions; weather; and both natural and manmade conditions of the course. I alone am responsible for my safety while I participate, and I should not participate unless I am medically able and properly trained. I have read and understood this waiver, and in consideration of acceptance of my application for the Rock Creek Ramble, I, for myself and anyone entitled to act on my behalf, waive and release the organizers (Meridian Geographics, LLC), the United States of America, the State of Washington, and all other land owners and land managers, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to the organizers to use photographs or audio/video recordings of me for any legitimate purpose.
Signature:______Date:______Parent or guardian must sign for participants under 18