2004 ALFERD PACKER MAIL-IN ENTRY FORM....PLEASE PRINT NEATLY

Postmark No Later than February 29, 2004

FIRST NAME:________________________    LAST NAME:___________________________________

STREET ADDRESS:___________________________________________________________________

CITY:__________________________________  STATE:____________  ZIP:_____________________

HOME PHONE #:_____________________________________________________________________ 

EMAIL ADDRESS:____________________________________________________________________

AGE ON MARCH 13, 2004 (RACEDAY):_________________        GENDER (CIRCLE):     MALE        FEMALE

EVENT (CIRCLE):        13.1-MILE            26.2-MILE            39.3-MILE        52.4-MILE

T-SHIRT SIZE (CIRCLE):    MEDIUM        LARGE        EXTRA-LARGE

13.1 MILE OR 26.2 MILE ENTRY FEE:  $50.00 postmarked through February 29, 2004.

39.3 MILE OR 52.4 MILE ENTRY FEE:  $70.00 postmarked through February 29, 2004.

CHECK PAYABLE TO:  SCOTT WEBER

MAIL COMPLETED ENTRY FORM, SIGNED AND DATED WAIVER, AND CHECK TO:

    SCOTT WEBER

    25 YACHT HARBOR COURT

    ISLE OF PALMS, SC    29451

AN ENTRANT LIST WILL BE MAINTAINED AT WWW.COACHWEBER.COM

2004 ALFERD PACKER RELEASE AND WAIVER

I wish to enter and participate in the Alferd Packer Trail Races on March 13, 2004. I agree with the rules, conditions, and regulations of the event and will comply with them. I am aware that this run is extremely difficult and is hazardous for even well-conditioned athletes under the most favorable conditions. I am physically fit and sufficiently trained to participate in this high altitude endurance event and assume all risks of such participation. The race covers difficult terrain and will cross through an icy river and I can be exposed to great extremes in temperature. I have been warned that I should not participate in this event unless: a) I am in excellent physical condition, b) I have run the distance of my race before on similar terrain and conditions, c) I have recently had a complete physical examination, preferably including a stress electrocardiogram, and even if I have, I have been warned that this race requires special care. I have also been warned that I may be exposed to physical injury from a number of natural factors, including but not limited to snow and ice on the trail, lack or overabundance of water, animals, and to the hazards of vehicular traffic, and to those other hazards attendant to running along or across roadways. These factors include, among other things, the fact that I may become injured or incapacitated in a location where it is difficult or impossible for the event's management to get required medical aid to me in time to avoid physical injury or even death. I have been warned that medical aid will be provided by calling 911 and that there is no medical personnel working at this race. Knowing these facts, I nevertheless in consideration of your accepting this entry, hereby for myself, my heirs, executors and administrators, waive, release and discharge the Scott Weber, the Colorado Ultrasport Club, the Alferd Packer Trail Races, Jefferson County, Douglas CountyCity of Littleton, USATF, Colorado State Parks, U.S. Corps of Engineers, any official sponsor entity, and the officers, directors, shareholders and/or members, agents, and employees of each, all medical and other personnel assisting with the race, volunteers, or any other person connected with this running event, their representatives, successors and assigns, from any and all rights, claims or liability for damage for any and all injuries to me or my property, or damage caused by me or by anyone else (including Acts of God), arising out of or in connection with my participation in this event. I further agree that I will defend, indemnify and hold harmless Scott Weber, the Alferd Packer Trail Races, Jefferson County, City of Littleton, USATF, Colorado State Parks, or any official sponsors, and the directors, officers, members and agents of each, against all claims, demands and causes of action, including court costs and attorneys fees directly or indirectly arising from any action or other proceeding brought by or prosecuted for my benefit contrary to this agreement. This release extends to all claims of every kind and nature whatsoever, whether known or unknown. I grant my irrevocable permission to the Alferd Packer Trail Races and its authorized agents, to use my name and any photographs, video tapes, motion pictures, recordings, or any other record of my participation in this event. No entry will be accepted without a signature. Race management reserves the right to refuse any entry. There are no refunds of entry fees for any reason including cancellation of the race. I am 18 years of age or older.

The essence of this waiver and release is that the Alferd Packer Trail Races present extreme and unknown risks for which I freely and voluntarily agree to be solely responsible in order to enable this event to take place, and, my participation in it.

SIGNATURE:__________________________________________________

DATE:            __________________________________________________
 

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