Race Application for NCS Race Events
Event Payment: Makes checks payable to NCS/(event). Complete this application and bring it to the race event to save time.
Application: Download PDF to print and mail.
Please Print Clearly:
Name: (Last)____________________________
(First)________________________________
Sex: M F
NCS Member? Yes No
Would you like membership information sent to you ? Yes No
Age on Race Day:_________
Date of Birth _____________
Address:________________
City: ____________________
State:___________________
Zip:_____________________
Telephone: ______________
E-mail:__________________
Race: ____ 10 Mile Run _____10 Mile Early Bird ___ 5K Run ____ 5K Walk
T-Shirt: (Circle one) - S M L XL (Adult Sizes) - preregistration encouraged & ensure receiving correct size while supplies lasts.
Waiver: I know that running a road race is potentially a hazardous activity. I should not enter and run or walk unless I am healthy and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the race. I assume all risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of weather, and traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I for myself, my heirs and anyone entitled to act on my behalf, waive and release forever the North Coast Striders, the County of Mendocino, and all volunteers, sponsors, their employees, representatives and successors from all claims and liabilities arising out of my participation in this event. It is also understood that due to insurance exclusion, skates, skateboards, skooters, radio headsets and portable sound systems are not allowed on the course during the race.
Signature:_______________________________________________
Date:_______________________________
(All participants must sign; parent/guardian must sign for participants under 18)
