Surf Racer Sports ---P.O. Box 199, Rehoboth Beach, DE 19971----P: 302-227-7667
Please complete and sign registration form and mail with check or money order to Surf Racer Sports.

Circle Event: Overfalls Lightship Aquathlon & 5 K Walk (7/21/07), Rehoboth Main Street Aquathlon & Walk (9/2/07)

            
Name: _________________________________________________________________________________

Street Address: __________________________________________________________________________

City: _______________________________________State: __________________ Zip: _________________

Birth date: _________________________________     Age (on race day): __________________________

Home Phone: ______________________________      Work Phone: ______________________________

Email address: __________________________________________________________________________

Circle Gender:      Female    Male

Circle T-shirt Size:   Small    Medium    Large    X-Large

Circle Division:     

Individual Male    

Individual Female   

Walker Male   

Walker Female

Team Male_________________________________        

Team Female_______________________________      

Team Coed ________________________________

Please include "team name"

__________________________________________  

Entry Fee: all entries are non-refundable, non-transferable and non-deferrable.

                $35.00 Individual, $40.00 Team, $15.00 Walker

USAT Member Status:

_____ Member    ______ Pending   

_____ Need Single Event permit (add $10.00)

All participants, including both relay team members , must show proof of USAT membership at check-in or purchase a single event permit for $9.00. Please include this fee with your registration.

Walkers are exempt from the USAT membership requirement.

Make Check or money order payable to: "Surf Racer Sports"
Waiver: Read and Sign. In submitting my entry, I, for myself, my heirs, executors and administrators, do hereby waive and release any and all claims for damages I may have now or here after arising against, all sponsors and their employees, officers, directors, principals, agents, representatives, successors and assigns, including but not limited to, any and all damages, injuries, demands, actions, whatsoever however they may occur, arising as a result of my participation in said events. I acknowledge that I am aware of the inherent risks associated with participation in events of this type. I attest and verify that I am physically fit and have sufficiently trained for the completion of these events and a licensed medical doctor has verified my physical condition. I understand that the entry fee is nonrefundable and race numbers are nontransferable.