Individual or Teams of 2 or 3
7:00am Registration - 8:00am Race Start
Individual Categories: 12 & under, 13-18, 19-29, 30-39, 40-49, 50+
Teams: 2 or 3, any age or gender
Awards: Individual - Overall Male / Female winners
1st and 2nd place per age category
Teams of 2 - 1st & 2nd place awards
Teams of 3 - 1st & 2nd place awards
Questions or additional information, please contact Teri Hartzler at YMCA of Washington
Name_____________________________________
Phone_____________________________________
Parent name (if under 18)______________________
Email______________________________________
Address____________________________________
City_____________________ State______ Zip_______
Age_______ Birthdate________ M / F
T-shirt size:
Youth: M L Woman or Male Shirt S M L XL XXL
Registration:
Early bird discount - Individual $40 Team of 2 $60 Team of 3 $90 (through 7/23/15)
Regular Entry Fee - Individual $50 Team of 2 $70 Team of 3 $100
I understand that I am legally agreeing to the following statements in the paragraph of this waiver by signing below. I acknowledge that biking and running on an open course is extremely dangerous and can bring with it the potential for death, serious injury, and property damage. My signature below is acknowledgement that I am at my own risk. I understand that this is a public event and not an event related to, or sanctioned by any organization. I am aware I will be on public roadways and vehicles may not be aware of my presence. I realize I am solely responsible for myself and my own safety. I do not hold the YMCA of Washington County, the City of Washington, Washington County or it's volunteers responsible for any risk of injuries which may occur because of my participation.
Signature____________________________________________ Date___________________
Signature of parent/guardian____________________________ Date___________________
Mail this form to:
121 E Main St., Washington, Ia. 52353
Online registration:
http://washingtonymca.myonlinecamp.com/
