TourdeKale Ride and 5k night run and walk - Cost and registration form

·  5k night road race and bike ride -  $45.00

·  135k - extreme summit challenge -$35.00

·  110k rolling to hilly challenge -      $35.00

·  60k - moderate to rolling -           $35.00

·  25k - moderate ----------------  $35.00              

·  [Lunch included] registration is $40.00 day of ride.

·  5k night road race - $20.00 ~ 1 mile fun run - $20.00 ~ Walk - $20.00 - please add $5.00 if you want lunch on Saturday

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PARTICIPANT INFORMATION (Please Print)

(Circle one)  SELECT COURSE: 135 SUMMIT CHALLENGE 110K / 60K / 25K / 5K NIGHT RUN 1 MILE FUN RUN-WALK

FIRST/LAST NAME: ___________________SEX: MALE / FEMALE

AGE (DAYOF EVENT):________

ADDRESS: ________________________   EMAIL: _____________________________________

CITY-STATE-ZIP________________________SELECT SHIRT SIZE:   S M L XL XXL

HOME PHONE: _____________________ FUNDRAISING GOAL: ________________

EMERGENCY CONTACT.EMERGENCY PHONE: ________________________________

Bubba Division 200 + lb male competing in the 135k Summit Challenge (circle) Yes No

Cat Division, (Please check)   Novice____ 5____4____3____2____1____

 

PLEASE ENCLOSE A CHECK OR MONEY ORDER IN THE CORRECT AMOUNT WITH YOUR REGISTRATION FORM. (MAKE CHECKS PAYABLE TO CANAAN UNITED METHODIST CHURCH TDK FUND) I ACKNOWLEDGE THAT MY REGISTRATION FEE AND ANY DONATIONS THAT I MAY RAISE WILL NOT BE REFUNDED IF I CHOOSE NOT TO PARTICIPATE IN THE EVENT.

PLEASE SIGN THE WAIVER

LIABILITY RELEASE AND WAIVER

For and in consideration of the right to participate in the Tour de Kale event, the undersigned does hereby release, absolve and hold harmless Canaan United Methodist Church, their sponsors, heirs, successors, assigns, volunteers, agents, and personnel from any and all actions, cause of action, liability or responsibility what so ever, or any injury, harm, loss or inconvenience suffered or incurred by the undersigned during or as a result of taking part in the Tour de Kale. The undersigned further understands that obedience of traffic regulations and signal devices is his or her own responsibility. The undersigned understands and agrees that the sponsors make warranties what so ever and are not responsible for one's safety during the Tour de Kale, or while traveling to and from the Tour de Kale. I, the undersigned, have fully read, understand and agree to all terms contained herein and so signify by signing and dating below.

 

Signed ______________________________   Date_______________________

 

 18 years of age, a parent or guardian must read and agree to the above conditions and is consenting to entrant’s participation. If agreeable, he or she must sign and date above.

Mail to:  TDK c/o Sheri Skeen   - 726 Mountain Shore Drive,    Denton, NC 27239