ENTRY FORM

I HAVE READ THE RELEASE OF LIABILITY and ASSUMPTION OF RISK AGREEMENT AND THE RULES LISTED ON MAIN PORTION OF THIS WEBSITE, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN BELOW FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Please print 2 copies, fill out and return one copy of the entry form to the Sullivan Trail Chapter of the American Red Cross, 911 Stowelll St. Street, Elmira, New York 14901-1428, (607)734-3317. Keep the second filled-in copy and present it at weigh in. Make sure to include your $25.00/person entry fee, additional $5 for Lunker Prize entry, with the mailed in copy. Make checks payable to the Sullivan Trail Chapter, American Red Cross. All Entry Forms must be postdated no later than July 7, 2008. No refunds. All registrants under the age of 18 years must have their signature accompanied by a signature of a parent or guardian.

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Please Print Legibly

  Name:______________________________________________________________
                            First                                                           Middle                      Last

  Address: ____________________________________________________________

  Address 2: __________________________________________________________
                                 City                                                           State                      Zip

  Do you want to be eligible for the CCU Lunker $1000 prize ($5 additional)? : YES - NO
            (circle one and remember to add the $5 to your mailed in total
                                                                                                             

  Signature: __________________________________________________________

  Parent or Guardian signature for under 18 entrant:

_________________________________________________________________________________

For PARENTS/GUARDIANS of participants of MINORITY AGE (Under age 18 at time of registration):
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his\her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.