2017 Birdsboro Rustic Rage Duathlon
05/21/2017
 
2017 Birdsboro Rustic Rage Off-Road Duathlon and Relay
Individuals or 2 Person Teams may enter
For team competition one member must do both run legs and the other must do the Mt biking
Divisions are as follows: COED, MALE, FEMALE and MASTERS (both members 40+)
**PLUS-COED MASTERS if more than 3 teams register
If entering as a team, please enter 2nd team member's info in appropriate boxes.
Details and race-day or mailable registration can be found at: http://makebreak.com
  
* First Name:   * required fields
* Last Name:
* Street Address:
* City:
* Select a State:
* Zip/Postal Code: 5 digits only
* Gender: Male    Female
* Age on day of race:
* Date of Birth: MM/DD/YY
* Email Address:
Phone:
Best time to call: Day   Evening   Either
Already receiving Weekly Email Run Updates? Yes    No
TEAM NAME and DIVISION
NAME of 2nd Team member
AGE of 2nd Team member
EMAIL of 2nd Team member
SHIRT SIZE of 2nd Team member
Parent/Legal Guardian Name (required if under 18 on day of race):
 
Race(s)
Individual at 9:00 AM: ( $40.00 plus $4.50 service fee through 05/16/2017 )
 
2 Person Team at 9:00 AM: ( $60.00 plus $5.70 service fee through 05/16/2017 )
  Please enter 2nd Team members info in appropriate boxes above.
 

  WAIVER: WAIVER / HOLD HARMLESS CONTRACTUAL AGREEMENT: By signing this contractual agreement I acknowledge the fact that participating in the Rustic Rage Off-Road Duathlon is a potentially hazardous activity and I am competing with full knowledge of all potential risks and injuries. I will not enter and race unless I am medically able and properly conditioned and trained for the level of competition that I aspire to. I also know that, although, some safety protection via course officials will be provided, there can be many hazards on the course route. I also assume any and all other risks associated with this event including but not limited to falls, contact with other participants, the affects of weather, including high heat and or humidity, the condition of the roads and all risks being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry, I hereby for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, convenient not to sue, and waive, release and discharge Breakaway Sports, Officials of the event and any other sponsors or associated organizations, including their Police Department; Race Officials, Volunteers, or any of the employees, agents, assignees or anyone acting on or for their behalf, from any and all claims or liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or the course of, my participation in this event known as the Rustic Rage Off-Road Duathlon. All costs incurred for medical assistance, be it ambulance, hospital, etc., is my sole responsibility and my financial liability. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. The undersigned further grants full permissions to the race organizers, sponsors, producers, and directors and or agents authorized by them, to use any photographs, videotapes, motion pictures, sound recordings, or any other record of this event for any purpose, be it promotional for remuneration to the aforementioned parties, without financial or other compensation or royalties to the event participant named herein. Applicants understanding and agreeing to this Waiver / Hold Harmless Contractual Agreement as specified herein and the rules of the event and decision of race officials should sign the entry form on the space provided below. I also agree that I am signing this contract and am competing for consideration of medals, awards and or prizes as named for the event.

 

Shirt Type
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