| |
 |
|
| |
Print
and return by mail or fax with your registration and processing
fee.
Event limited
to 600 skiers. No
entries will be accepted after 2/25/07.
|
|
| |
Cancellation
Policy: Cancellations before 2/15/07 will be charged a $30 cancellation
fee. No refunds
will be made after 2/15/07. The event committee may modify or shorten
the
event due to weather conditions. Entry fees are not refundable
due to event cancellation, nor are they transferable to another person
or event. |
|
| |
|
| |
|
| |
|
|
PARTICIPANT REGISTRATION: |
|
| |
Name:
________________________________________________ Club/Team: _________________ |
| |
Address:
___________________________________________________________________________ |
| |
City:
_______________________________________ State: ___________ Zip: __________________ |
| |
Phone:
___________________________ E-mail: __________________________________________ |
| |
Birthdate:
_______________________ Male:
Female:
|
|
| |
Age
Group Classification: (M
stands for Master) |
|
| |
| JR. |
19
and under |
M2 |
35
to 39 |
M5 |
50
to 54 |
| SR. |
20
- 29 |
M3 |
40
to 44 |
M6 |
55
to 59 |
| M1 |
30
- 34 |
M4 |
45
to 49 |
ETC. |
(5
year categories) |
|
|
| |
|
| |
Age
as of 1/1/07: ________ Age
Group Classification (from above):
________ |
|
| |
Event
Distance: 50 km _____ 25 km _____ Class:
Timed:
Non-timed:
 |
|
| |
Are
You a NENSA member? Yes:
No:
If
so, membership #: __________________________________ |
| |
Are
you entering the Rangeley Lakes Loppet 50 km on 3/3/07 for the
Double Marathon Challenge?
Yes No |
| |
|
|
SHUTTLE TRANSPORTATION: (free
to participants) |
|
| |
Event
starts at Great Glen Trails Outdoor Center and finishes at Bretton
Woods
Nordic Center. Shuttle bus service available to the start at Great Glen
from various points. |
|
| |
|
| |
I
anticipate taking the shuttle to the start at Great Glen: Yes
No
|
|
| |
From
pickup point (if
known):
Bretton Woods
Twin Mountain
Gorham
|
|
| |
For
25 km participants: I plan to use shuttle from 25 K finish
to: Bretton Woods
or
Great Glen
|
| |
I'd
like to take shuttle back to Great Glen after the awards: Yes No |
|
| |
|
|
ENTRY FEES: Please
make checks payable to "GG to BW Nordic
Adventure" |
|
| |
Paper
Entries: Please add $5
processing charge to entry fee. |
|
| |
Timed
Classes, 25/50 km: |
|
| |
Postmarked:
by 12/31/06___$65
by
1/31/07 ___$75
by
2/18/07 ___$85 after
2/18/07 ___$95 |
| |
Non-Timed
Classes, 25/50 km: |
|
| |
Postmarked:
by 1/31/07___$50
by
2/18/07 ___$60 after
2/18/07 ___$70 |
|
| |
|
|
PAYMENT:
Cash
Check
AMEX
Visa
MasterCard
Discover
Card |
| |
Card
No. __________________________________________________ Exp. Date _______________ |
| |
Signature:
_________________________________________________________ Date: __________ |
| |
|
|
WAIVER: |
|
In
consideration for the rights and privileges associated with participation
in the TD Banknorth Great Glen to Bretton Woods Nordic Adventure,
a New England Nordic Ski Association event, I acknowledge and agree
to be bound by the following: 1. Identification of Risks. I
understand that participation in any skiing activity, including but
not limited
to, preparation for, participation in, and coaching of activities
in cross-country ski competitions and events, involve risk of serious
injury, including permanent disability, death and other losses, due
to inactions or negligence of myself or others. 2. Assumption
of the Risk. I agree that I am responsible for my safety
while participating in activities associated with NENSA, and that
such responsibility
includes participation only a) when I am both physically and psychologically
prepared to participate safely, b) after fully familiarizing myself
with the venue before beginning the activity, and c) while using
the equipment of a type and condition reasonably necessary to safely
participate. I assume all risk connected with responsibility for
any injury or loss connected with my participation. 3. Waiver. Aware
of the risks and willing to assume them, I hereby release and agree
to hold harmless the New England Nordic Ski Association (NENSA),
its officers, directors, employees, agents, coaches, trainers, doctors,
officials, volunteers, affiliates, event organizers, [specifically
Great Glen Trails/Bretton Woods Ski Area], sponsors, owners of property
and trails used by me (Released Parties) from
loss, injury,
or death to myself or to any other person, or other damage to person
or property resulting from my participation in events and competition
and any related activities including, without limitation activities
in connection with sponsorship, organization or execution of any
event and travel to and from such event, whether I may participate
as an athlete, coach, volunteer, spectator, or in any other manner
associated with NENSA. This release is intended as a waiver of any
claim I may have whether based upon negligence, breach of warranty,
contract or other legal theory, against any of the above Released
Parties, accepting myself the full responsibility for any such loss,
injury, death or damage which may result. I intend for this release
to also apply to my relatives, personal representatives, heirs, beneficiaries,
next of kin, and assigns. If any part of this agreement is determined
to be unenforceable, all other parts shall be given full force and
effect. This waiver does not release acts of gross negligence or
willful and wanton misconduct of any party. 4. Insurance. I
currently have, and agree to maintain throughout the time that I
train and
participate, valid and sufficient medical and accident insurance.
I understand that this is my sole responsibility and release all
persons and entities from providing this coverage for me.
PHOTOGRAPHY
RELEASE: I hereby grant absolute right and permission
to Great Glen Trails and Bretton Woods Ski Area to use photographic
portraits of me for illustration, promotion or advertising purposes.
|
| |
|
|
| |
Signature:
_________________________________________________________ Date: __________ |
| |
Parent/Guardian
(for athletes under 18 years of age):
|
|
| |
Printed
Name : _____________________________________________________________________ |
 |
| |
Send
to: TD Banknorth GG to BW Nordic Adventure
PO Box 278, Gorham, NH 03581
Phone: 603.466.2333
Fax: 603.466.3328
E-mail: sue@greatglentrails.com |
|
| |
|
| |
|
| |
|
| OFFICE
USE ONLY: Date entry received: __________ Release signed:_____
Amt. Paid: __________ Initials: _____ |
 |
 |
 |
 |
 |
 |