Name:  
      Address:  
         City:  

        State:     Zip: 
Business Phone:  Date of Birth:  Age on race date: 
Home Phone:     
Email Address:  	   
	   Race Distance: 34M 21 Mile 25K 8 Mile
	   Race Entry: $60$40(21M/25K) $30(8M)
	   Late Entry(9/2-9/24/10 Postmarked): $65 $45(21M/25K) $35(8M)
	   Race Day Entry: $75 $55(21M/25K)$45(8M)
	   Extra BBQ Ticket: $7
	   Gender: M F
           T-shirt Size:  S M LG XL
	  	    

Waiver Must Be Read and Signed Before Mailing:
In consideration of my entry, I myself, heirs, executors, administrators, and assigns waive and release any and all rights and claims against the Gold Country Trail Runs 34M/21M/25K/8M, also any related coordinators, sponsors, volunteers, supporters,Ultrarunner.net, Lake of the Sky Trail Runners Running Club, California State Parks, Bureau of Reclamations, Bureau of Land Management, and employees of Auburn, California. I further attest that I am physically fit and have trained for this said event. I also agree to any/all medical treatment to be administered to me during or after completion of this event. I also waive any negative or positive input to the above race director during this event and will withdraw at the request of the above. I also accept full responsibility for my actions, etc. All fees are nonrefundable. Shirt/sizes not guaranteed for late or race day entries. A $25 Service Fee for all returned checks.

___________________________________  _____________ 
Signature                            Date