Tuesday, October 20, 2009

End to End Hiking Challenge will take place on Saturday, May 15th 2010: Registration Form

29 mile End to End Hiking Challenge, May 15th 2010
Registration Form
(Copy and Paste this page)

Please include a $30.00 registration fee. This fee is non-refundable after March 31, 2010. Checks should be made payable to the Taconic Hiking Club and mailed to Pam Bailey, 39 Fane Court, Troy, NY 12182. Completed registration forms will not be accepted until January 1, 2010. There will be a ceiling of 25 entrants for this event, with each application handled on a first received, first served basis. Additional entrants will be placed on a waiting list in case of cancellations. All applicants must be 18 years or older.

I, the undersigned, declare myself physically fit and able to participate in the above event. I realize that hiking events such as this are physically strenuous and hereby agree to be solely responsible for my own safety during this 29-mile hike.

I also acknowledge, agree and release the Taconic Hiking Club and any and all of its volunteers from any and all liability claims, losses and/or damages for personal injuries or death which may occur while participating in this event. I also permit these same volunteers to place my camping gear and related items in my designated car, to drive said car to the finish line and to release said volunteers from any liability claims or damages in the course of automobile traffic.

Name__________________________________________Date_______________

Address___________________________________________________________

_________________________________________________________________

Phone _____________________________Email________________________________

Emergency Contact Name &

Phone_____________________________________________________________

Signature___________________________________________________________

Name and address of hometown newspaper for press release after the challenge

__________________________________________________________________

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