THE GOLD RUSH SUMMER CHALLENGE

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					             THE GOLD RUSH SUMMER CHALLENGE
             Six-Hour Adventure Race 2011
             Official Entry Form

MAIL TO: GoldRush AR, 1521 De Ve Ave, Modesto, CA 95350.                    (209)-575-3041
                Team member 1:                            Team member 2:

Team Name:________________________________________
First Name      ___________________                       _________________
Last            ___________________                       _________________
E-mail          _____________________                     ___________________
Address         _______________________                   _________________________
City____________State____Zip_______                       _____________              ___ _______
Age Race Day: _________ M__F__                            Age: _____ M __ F __
Shirt size (S,M,L,XL,XXL) ______                          _______
Home Phone        _________________                       _________________
Work Phone        _________________                       _________________
Emergency Contact ___________________                     ______________________
Emergency Phone ___________________                       ______________________

ENTRY FEE: Two person team $140.oo                   $______             (Note:Race entry fee
($70.oo/person , $50.oo under 25)                                        does NOT include boat.
                        Teams must supply canoe, kayak or raft.or call ‘GoldRush AR’ for help.)

CAMP SITE Fri.& Sat: Per Team $20.00                      $______
(Additional charge if more than 4 persons)

POST-RACE MEAL:
Two team members and one crew included in entry fee.
Additional persons, $5.oo/person                     $_______

LATE ENTRY: After May 15th, 2011, $20.00 per Team         $_______
                                                          ---------------
TOTAL FEE SUBMITTED                                       $_______


LIABILITY WAIVER: In consideration for accepting my entry I, intending to be legally bound, hereby for
myself, my heirs, executors and administrators, waive and release any and all claims against persons and
organizations affiliated with the race, Gold Rush Summer Challenge, while participating or traveling to or
from the race. I further attest that I am physically fit for this race and am able to swim.

Signature team member 1 ___________________                         Date ________
(parent or guardian if applicant is under 18)
Signature team member 2 ___________________                         Date ________
(parent or guardian if applicant is under 18)

                      * Race packet and gear list will be mailed on receipt of entry. *

				
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