Cheesehead Chase

Registration Form (print & mail)

chcregistrationform.pdf
File Size:	260 kb
File Type:	pdf

Download File

Online Register Open

Please complete the form and submit.

Name *

First

Last

Group Name *

Gender *

Event *

Age Day of Race (Required for Runners) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Entry Fee *

Tshirt (Ladies/Men/Youth) *

No Guarantee of Tshirt if Registration entered after June 26th, 2017.

Please review and sign below:
In consideration of your acceptance of this entry, I hereby, for myself, my executors and administrators, waive any and all rights and claims for damages I may have against the sponsors, coordinating groups, and any individuals associated with the event, their representatives, successors and assigns, and will hold them harmless for any and all injuries suffered in connection with said event. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connection with the said event. I have been warned I must be in good health to participate in this event. I also give permission for the free use of my name and picture in any broadcast, telecast or print media account of this event. In filling out this form, I acknowledge I have read and fully understand my own liability and do accept restrictions.

Signature *

First

Last

Mail Check Payable to:
PBW
PO Box 324
Plymouth, WI 53073

Any issues or questions, please email Registration@CheeseheadChase.com

Parent's Signature (if under 18) *

First

Last

Submit

25th Annual