Siren, WI Freedom Five Race Registration Form
FILL OUT ONE REGISTRATION FORM PER PARTICIPANT

WAIVER: In consideration of filling out and sending this agreement, I enter this event at my own risk and assume any risk or responsibility for injuries I may incur as a direct or indirect result of participation in this event.

I also agree not to hold liable any representative or employee of the Siren Chamber of Commerce
the Village of Siren, Township of Siren or Burnett County WI for said injuries.
Today's Date: *
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Race Entered *
Last Name *
First Name *
Age as of July 4, 2021 *
Sex *
Birth Date *
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Telephone Number *
Shirt Size *
Mailing Address *
City *
State *
Zip *
Email Address *
Age Group *
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