Napa Valley Inline Marathon & Half Marathon

June 28, 2009 please print

name______________________________________________________________________

address_____________________________________________________________________

city / state___________________________________________________________________

zip______________age_______sex_____

phone___________________________________Cell_______________________________

Team Name________________________________________________________________

e-mail___________________________Web Page__________________________________

Circle Age Category

PRO ELITE - No Age Categories


JUNIOR 13 AND UNDER INTERMEDIATE 14-17 SENIOR A 18-24 SENIOR B 25-29

VETERAN A 30-34 VETERAN B 35-39 MASTER A 40-44 MASTER B 45-49

GRAND MASTER A 50-54 GRAND MASTER B 55-59 IMMORTAL A 60-64

IMMORTAL B 65 - 69 PRICELESS 70 & UP

RELEASE OF LIABILITY AGREEMENT

The undersigned applicant hereby agrees to and does release David G. Miles Jr., D M J Inline Sports Marketing, the California Outdoor Rollerskating Association, the City and County of Napa, the City of Calistoga, the Golden Gate Park Skate Patrol, the Boy Scouts Of America, or any other associated entities (herein known as "sponsors") from any responsibility and liability arising out of the applicant's participation in the "Napa Valley Inline Marathon and Half Marathon". (herein referred to as roadskate")

The undersigned applicant agrees to and acknowledges that he or she assumes all risk incident to his or her involvement in the roadskate. The applicant agrees that he or she will not sue or make any claims whatsoever against the sponsors

Applicant acknowledges that this event involves skating up and down hills on state or county roadways and agrees to obey all event rules, traffic laws, local police, and California Highway Patrol during the roadskate.

Applicant and those signing in their behalf agrees further that the term "applicant" includes the undersigned and his or herheirs, assigns, agents and legal representatives and that the term "sponsor" includes all past, present and future subsidiaries, franchises, affiliates, officers, directors, employees and agents of the sponsors including their heirs, agents and legal representatives.

Applicant hereby authorizes D.M.J. Skate Sports Marketing to videotape, photograph, or otherwise record the image of the applicant during the roadskate.

Applicant ignature______________________________________________________date____________________

parent/guardian_____________________________________________________________________

parent/guardian phone________________________________________