Rucky Chucky Roundabout 50K Run/50K Relay

2009 Race Application

  

    

      


      
          Mail-in Registration Form

           Rucky Chucky Roundabout 50K Run - March 21, 2009

		  
       
 

  

    
Make Checks Payable To:
    
UltraRunner.net
  

        
Mail Entry To:
        
Rucky Chucky Roundabout 50K Run


Attn: Robert Mathis


301 Ferry Circle


Folsom, CA 95630


E-Mail: robert@ultrarunner.net

  

         Name:  
      Address:  
         City:  
        State:     Zip: 
Business Phone:  Date of Birth:  Age on race date: 
Home Phone:     
Email Address:  	   
	   
	        
	   Race Entry(Postmarked by 2/20/09): $65
	   Late Entry(Postarked 2/21-3/14/09): $75
	   Race Day Entry: $85
	   Extra Buffet 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 Rucky Chucky 
Roundabout 50K Run/50K Relay, 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,
Foresthill Elementary School, and employees of Foresthill, 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.

                   

        


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Parent Signature(if under 18)               Date