2008 King of the Mountain Registration Form

 2) Address: _______________________________________________________________

 3) City:________________________________________________4) State:______ 5) Zip:___________

 6) Phone:  (       )  ____________________                     7) Email address:_________________________

 8) Age on Race Day:  _____________________              9) Sex:  M   or   F

 10) Type of Bike:  Mountain Bike or Road Bike  or Tandem or Citizens' Relay (Please circle for type of bike)

 11) T-shirt Size:  S or M or L or XL or XXL   (Please circle for shirt size)

I hereby certify that I am in good physical condition and hereby assume all risks and liabilities related to my participation.  I hereby for myself, my heirs, executors, administrators, and assigns, release Habitat for Humanity of Clearfield County, Habitat for Humanity International, Pennsylvania Department of Transportation, all landowners, any municipalities or other public entities (and their respective agents and employees and all volunteers and sponsors from all claims for injury suffered by me while participating in this event.  I also understand that the entry fee is non-refundable.  I also give me permission for free use of my name, picture, or likeness for any purposes related to the race.

  Signature of Parent/Guardian if age 18 or under:_______________________________

  Date: ___________________________________________________________________
 
  Make Checks Payable to:  Habitat for Humanity of Clearfield County
  Print out this form and mail the form and fee of $20 ($40 for a tandem or Citizen's Relay team) to: 

  Habitat for Humanity of Clearfield County

  P.O. Box 463

  DuBois, PA  15801

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