ENTRY FORM

(fill out one form for EACH team member)

(and as always, please print legibly)

NAME ______________________________

CATEGORY __________________________

TEAM NAME _________________________

STREET ADDRESS ____________________

CITY, STATE, ZIP ____________________

PHONE _____________________________

EMAIL ______________________________

(for notification of future events, names will not be sold)

SEX: MALE/FEMALE

Hold Harmless: In consideration of the acceptance of this entry, I hereby, for myself, my executors, administrators, and assigns, do release and discharge Triangle Cyclopaths, Devil’s Ridge Motocross Park, the county of Sanford, the sponsors, and all race personnel from any claims for damage suffered by me as a result of my participation in or traveling to or from said events held on

November 5, 2005. I further certify that I am in proper physical condition to participate in this event, and accept full responsibility for my own safety during the event.

__________________________ _________________

Signature of Participant Date

__________________________________________

Signature of Guardian if Under age 18 Date

Emergency Contact Information

Contact:______________________________

Phone:________________________________