 |
Competitor Registration
Form |
|
CANADIAN NATIONAL CHAMPIONSHIPS 2004 |
Including the Canadian College & University
Nordic Championship |
CCC Racing License
required - Entry deadline Mar. 4, 2004.
There will be a late fee of $10.00 for entries
received Mar. 5th - 8th. Entries received after that time will
not be accepted.
Please check the box in each event you will be registering for,
and the class you will be participating in. |
|
Banquet $20 - Friday, March 19, 2004 |
|
After completing the form, print,
sign, and mail to the Race Secretary
no later than March 4, 2004.
 (
Form prints best with left/right margins at 0.5" and top/bottom
at 0.7" )
Full payment is due by Thursday, March 4, 2004. Online
credit card registration here. |
All cheques are payable to: Les
Aventuriers de Charlo Inc.
REGISTRATION:
Send this registration form to the Race
Secretary: |
| Sally Reinsborough
456 Sunset Dr.
Dalhousie, NB
E8C 2M2 |
If you have questions about registration, please call
Sally at 506-684-5930 or email
secretary@skinationals.com |
| |
| RELEASE and WAIVER
In consideration of Cross Country Canada ( hereinafter called
CCC ) and Les Aventuriers accepting my entry in the above named
event, I hereby for myself, my heirs, executors, administrators
and assigns, forever release and forever discharge CCC, its clubs,
servants, agents, sponsors, or employees from any claims, demands,
actions or causes of actions arising out of or in consequence
of any loss, injury or damage which may arise by reason of negligence
of CCC, its clubs, servants, agents, sponsors or employees. Without
limiting the generality of the foregoing, I further release any
or all recourse which I may now or hereinafter have resulting
from any decisions of CCC or Les Aventuriers.
Adult Participant - Release and Waiver.
As a participant in the above event, I have read and understood
the above.
|
| Name of Participant |
Print ________________________________________
|
|
DATE |
_____________ |
Signature________________________________________ |
| Minor Participant - Release and Indemnification
As the parent or guardian of a participant under the legal
age of 18, I have read the above and accept its terms and conditions
on the entrant's behalf. |
| DATE |
_____________ |
Signature of
Parent or Guardian |
________________________________________ |
| |
|
Signature of
Division Chair or Coach |
________________________________________ |
PHOTO RELEASE
Cross Country Canada and Les Aventuriers occasionally
use videos and photographs of people and events for purposes of
marketing, advertising and promoting Cross Country Skiing. The
videos and photographs taken at the 2004 Canadian Cross-Country
Ski Championships will be used for these purposes and to produce
a video of the championships that will be broadcast. Therefore
we would ask you to please sign this form so that any video or
photograph in which you might appear may be used.
I, _____________________________________, do hereby
grant Cross Country Canada and Les Aventuriers the right to use,
without fee or payment, my videotaped, photographic or other media
likeness for use in furthering Cross Country Canada's objectives
and to promote Cross Country skiing in promotional materials,
publications, posters, advertising or on Cross Country Canada
and the National Ski Championships (skinationals.com) web sites.
I will expect nothing in return for any use of my image by Cross
Country Canada or Les Aventuriers. I release on behalf of myself
and my heirs, executors, representatives, successors and assigns,
Cross Country Canada and Les Aventuriers from any recourse or
claims which I may now or hereafter have resulting from any use
of my likeness by Cross Country Canada and Les Aventuriers.
Signature of Participant ( over 18)______________________________________________-
Signature of Guardian ( for participants under 18)
_______________________________________________
Please ensure all information above is correct.
|
|