New World Championship Snowshoe Races
Saturday, February 12, 2005 - 10 am

After completing, Please print this form and mail to:
Larry Linder/Snowshoe Races
1572 - 270th Ave.
Luck, Wisconsin 54853

Please include check or money order payable to:
In & Out of Luck Running Club

Name:  Last MI First
Address:
City: ST: Zip:   Phone #
Midwest Series Member:
Sex: Male: Female: Age: Date of Birth:
Email:
Snowshoe Races 2005 20K 10K 5K

Before 2/1/05 $20 $20 $20

After 2/1/05 - Race Day $25 $25 $25
FREE embroidered sweatshirt

Small

Medium

Large

X-Large
If there are any extra shirts on race day, they will be offered for sale.


I know that running this snowshoe race is a potentially hazardous activity. I will not enter and participate unless I am medically able and properly trained. I agree to abide by any decision of any race official as to my ability to safely complete this event. I assume all risks with competing in this event, including but not limited to falls, contact with other participants, and effects of weather. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, Myself and anyone entitled to act in my behalf waive and release the Village of Luck, County of Polk, Luck Public School District, Luck Country Club, In & Out of Luck Running Club, race officials, volunteers, and all sponsors from all claims or liabilities of any kind arising out of my participation in this event, I grant permission to all of the foregoing to use my name, photo or comments to publicize this event. I further agree that I will not go ballistic and cause a scene if I do not win a prize or if I simply have a bad day.
Signature (Parent must sign if competitor under 18) _____________________________
Date
____________