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 2004 high Peaks Cyclery 24 Hours of the Adks Mt. Bike Race Application.   24 Hour Race only- No 12 Hour for 2004.

Team Name:______________________________________________________

Team Captain:_____________________________________________________

Mailing Address____________________________________________________

City_________________________St/ Prov_______Zip/ PC__________________

Phone:(        )_________________________________Age________M/F_______

Emergency Contact Name____________________________________________

Emergency Contact Ph#_____________________________________________

Racer 2:______________________________Age_____M/F____ Race #_______

Racer 3:______________________________Age_____M/F____ Race #_______

Racer 4:______________________________Age_____M/F____ Race #_______

                                                               Age Total_________

   Categories -All 24 hours                  Mix         Male     Female   Entry  Fee

 Solo

 ???

 

 

$50

 Team age 99 or less

 

 

 

$200

 Team age 100 - 149

 

 

 

$200

 Team age 150 - 199

 

 

 

$200

Team age 200 plus.

 

 

 

$200

Example : If a team has four racers ages 25, 22, 35 & 30, the total age is 112 and the category would be 100 - 149. One member of a different gender than the others makes a team ``Mixed``. You may enter a team with less than four riders, but you will be grouped with the four person teams and pay the team price of $200.The team age will be the average age of riders x 4. If every team member is a full time student, the fee is only $100.

 E-Mail address of Captain/contact for entry confirmation.

________________@________________________________________

Entries received by fax or postmarked after Aug. 20th will have a $10 per rider late fee added! Late entries will accepted in person at the registration desk up to 10:00 on the morning of the event.

Credit Card # (Visa, Mastercard or Discover only.) _______________________________________Exp..Date (M/Y)____/____

Signature:_______________________________________________

Entry fee: $__________________( + $10 per rider late fee after Aug. 20th )

Headlight Rental ( $10 x ______) = $________

Total Amount paid : $_________

Method of Payment-U.S. funds only.

___ Cash     ___Check

____MC/Visa/Discover   ___Money Order

Check here if you need a headlight- $10 rental fee- CC deposit required. Quantities limited. First come/ first reserved.

Release of Liability   All participants must read and sign before being allowed to start!

In consideration of accepting the above entry, I, the undersigned, acknowledge and accept that there are certain inherent risks involved with the participation in the activities of these events. I accept responsibility for my actions while participating, preparing for and immediately following these events. I understand and agree that situations may arise during these events which may be beyond the control of the race sponsors, organizers and volunteers and will not hold them responsible for such situations. I agree to abide by the rulings of race officials for the safety of all participants. I also agree to abide by the laws of the trails with safety the primary concern. I attest to and verify that I am physically fit and adequately trained for the event, or events, in which I am participating. I  grant permission to the 24 Hour Race event organizers to utilize any photograph, motion picture, recording or other record of my use of such facility for any legitimate use.

Signature 1:_______________________________________Parent/Guardian ( If under 18 )____________________________________________

Signature 2:_______________________________________Parent/Guardian ( If under 18 )____________________________________________

Signature3:_______________________________________Parent/Guardian ( If under 18 )_____________________________________________

Signature 4:_______________________________________Parent/Guardian ( If under 18 )____________________________________________

 Print, fill out and mail to :High Peaks Cyclery, 331 Main St., Lake Placid, NY, USA 12946. Or FAX entry to: (518) 523-2368 by August 20th Ph. ( 518) 523-3764