ENTER RIDER INFORMATION

First Name
Last Name
Address
City
State
Zip Code
Phone
E-mail Address
Age
RUSA#
Sex

EMERGENCY CONTACT INFORMATION

Full Name
Phone

EVENT INFORMATION
(you may register for only one event)




RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ("AGREEMENT")

No
Yes
I have read and understand the above Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement ("Agreement"). I also understand that I will be required to sign this Agreement the morning of the Event.
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