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Rim Nordic Mt. Biking Registration Form

This form can not be submitted through email.
Please fill out registration form, print and fax or mail form to Rim Nordic Ski Area

USA #
Rim Nordic Racing Card #
Racing Age (Age as of 12/31/10):
Date of Birth: (mm/dd/yy):
Male Female
E-Mail Address:

Last Name:
First Name:
Address:
Apt #
City:
State: Zip:
Home Telephone:
Date of Race:
Category / Class Entered:
Sponsor / Team Name:

FAX ENTRIES PAID BY CREDIT CARD ONLY

NO REFUNDS
Male

Pro Open
Open 18 & Under
Open 19-29
Open 30-39
Open 40-49
Open 50-59
Open 60+

Female

Pro Open
Open 18 & Under
Open 19-29
Open 30-39
Open 40-49
Open 50+

 
FEES
Registration - $25 ($15, Jr.) $
Season Race Pass (4 Race Series) - $80 ($40, Jr.) $
No USA Cycling License Fee - $5.00 (Per Race) $
Mail Race Results - $1.00  $
Total $
PAYMENT
Visa Mastercard
Name on Card:
Card Number:
Bank :
Expiration Date:
CVC:
Signature: X_____________________________________________________

Mail or Fax to:

RIM NORDIC
P.O. BOX 2990
Running Springs, CA 92382
Phone: (909) 867-2600, Fax: (909) 867-4128

In consideration of this entry, I hereby for myself, my executors, administrators and assignees waive any and all right of claims for damages I may have against Rim Nordic Ski Area, Inc., all sponsors and individuals associated with said event for any and all injuries sustained by me in this event. Also, none of the above are responsible for the loss of personal items not any other form of aggravation in connection with the said event. I attest and verify that I am physically fit and have trained for this event. In signing this form, I acknowledge I have read and full understand my own liability and do accept the restrictions.

Signature (if minor, parent must sign) X_________________________________________________

Date Signed: _________________