21th ANNUAL SCREAMIN’ TELE LIZARD CLASSIC REGISTRATION March 11th 2017

Name (Please Print)______Phone______

Address______City______State______Zip______

Go Green! (Please print clearly) EMAIL: ______

CATEGORY: PLEASE CHECK APPROPRIATE GENDER AND AGE CATEGORY.

Female 45 & Under ______Female 46 & over ______

Male 40 & Under ______Male 41-55 ______Male 56 & over ______

FEES: Entry Fee with T-Shirt: Size S, M, L, XL$32 ______($37 on race day)

Entry Fee without T-Shirt:$20 ______($25 on race day)

Additional Donation to SPECIAL OLYMPICS=$ ______

Included in extra fun drawing ;-)TOTAL $ ______

MAKE CHECKS PAYABLE TO MT ASHLAND

(DISCOUNTED RACER LIFT TICKETS ARE AVAILABLE THE DAY OF THE RACE)

If you wish to charge it to your bankcard, please fill in below:

Print name as it appears on card:______Signature______

Master/Visa Card # ______-______-______-______Expiration Date: ______/______

Deliver to: Mt Ashland Main Ticket Desk in the Mt. Ashland Lodge or

Mt. Ashland Business Office, 693 Washington Street, Ashland 97520

Mail to: Mt Ashland, PO Box 220, Ashland, OR 97520

You must print, sign, and mail this Release and Indemnity Agreement

RELEASE AND INDEMNITY AGREEMENT FOR TELE LIZARD CLASSIC SKI RACE

March 11, 2017 I, ______(Participant’s Name), age ______hereby acknowledge, individually and on behalf of my successors and assigns, that I am aware of the inherent risks of skiing and duties of skiers under Oregon’s law ORS 30.985.

In consideration for permission to use the Mt Ashland ski facilities and participate in this TELE LIZARD CLASSIC SKI RACE, I hereby release Mt. Ashland Association dba Mt Ashland and its officers, directors, employees, agents, sponsors, successors, assigns and volunteers from any and all liability arising out of or in connection with my participation ( or participation by my minor child) in this TELE LIZARD CLASSIC SKI RACE, and the use of any equipment or facilities at the Mt. Ashland Ski Area.

I further agree to indemnify and hold harmless Mt. Ashland Association dba Mt Ashland, it’s officers, directors, employees, agents, sponsors, successors, assigns, including but not limited to ski instructors from any and all claims and liabilities (including costs and attorney’s fees) arising out of or in connection with the TELE LIZARD CLASSIC SKI RACE and use of any equipment or facilities at Mt Ashland, on behalf of myself and on behalf of any minor child of mine.

This indemnity includes claims based upon negligence, but does not include claims based upon gross negligence and wanton or willful misconduct.

Date: ______Participant’s Signature ______

Parent or Guardian: ______

If any term set forth in this agreement is determined to be unenforceable for any reason, the parties intend that all other terms of this Agreement shall be enforced ;-)

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