First Name Last Name Male Female
Age you will be on 12/31/08
Address City State Zip
Telephone E-mail
Emergency Contact (required) Phone
T-Shirt Size (adult sizes only, entries received after 06/15/08 not guaranteed a t-shirt) S M L XL
I hereby release all sponsors of this event from any and all claims of liability that may arise from my participation in this competition. I agree to allow Beartooth Run/Burn/Events Officials, Race Organizers and Media representatives the use of my name, photos, video tapes, comments or commentaries to help publicize and promote Beartooth Run/Burn/Events.
Class/Age Category (age on 12/31/07):
12 & Under 13-14 15-16 17-18 19-24 25-29 30-34 35-39 40-44 45-49 50+
Category/Skill Level (check one):
Cat 5 (Beginner) Cat 4 (Intermediate) Cat 3 (Intermediate +)
Registration price for these categories includes a USA Cycling Event license.
Cat 2 (Expert) Cat 1 (Expert +)
Registration price for these categories requires an Annual USA Cycling license.
License # (also available for purchase at race)
Entry Fee: Pre-registration (on or before June 15, 2008) .....$33 *includes $3 handling fee Registration (after June 15, 2008) ........................$38 *includes $3 handling fee
Entry Fee:
Pre-registration (on or before June 15, 2008) .....$33 *includes $3 handling fee
Registration (after June 15, 2008) ........................$38 *includes $3 handling fee
Total Charge $ * Numbers Only - No other Characters! ex: 35 NOT $35
