2010 Wasatch Powder Keg Entry Form

 

The Race and Recreational Divisions are $65 each. 

 

Pre-registration entries must be received by March 1.  All racers who pre-register will receive a 2010 Wasatch Powder Keg T-shirt.  Entries received after March 1 or same day registrations will not receive a T-shirt.  The race will be capped at 150 racers.

 

Directions
  1. While on screen TYPE in all values.
  2. PRINT, SIGN & MAIL with CHECK.                                                                                  

Name:

Address:

City:

State: Zip:

Country:

Birth Date (mm/dd/yy)

                   Age on 3/14/2010:

Sex:

Day Phone

Eve Phone:

Email:

T-shirt Size

Division

Race AT | Race Tele | Rec AT | Rec Tele|Splitboard

Powder Keg Races Finished 

'03  | '04 | '05 | '06 | '07 | '08 | '09

Emergency Contact

Emergency Contact Phone

Entries must be postmarked by 01March09

 

WAIVER: I realize that there are risks associated with competing in this event and in your consideration of accepting this entry, I, the below signed, intending to be legally bound for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damage I may have against any persons, officials, private property owners, organizations and/or sponsors of the 2010 Wasatch Powder Keg and their representatives, successors, and assigned for any and all injuries suffered to me in this event even though liability may raise out of negligence or carelessness on the part of any persons named in this waiver. Further, I grant full permission for any and all of the forgoing to use photographs, videotapes, motion pictures and recordings of me for any legitimate reason. Also, I understand that the race director and/or race officials, have the right to reject any entry and to pull anyone from the run who litters on the course outside of the aid stations.

 

Signature_________________________________ Date_______________

 

Check payable to "2010 Wasatch Powder Keg"

 

Mail to: 

2010 Wasatch Powder Keg

c/o Chad Brackelsberg

150 Aspen Lane

Park City, UT 84098