Boat Race Registration Shopping Cart

Lake Havasu, September 5 - 6

Application Deadline August 20

TEAM APPLICATION FORM

500-METER RACES:

Price

Total

OPEN DIVISION

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WOMEN DIVISION

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MIXED DIVISION

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Other Items

Additional T-Shirts:

All Sizes

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Youth:

Small:

Medium:

Large:

X-Large:

XX-Large:

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Personal Information

E-Mail:*
Valid e-mail is required

Phone:*

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Date of Birth*

Height:*

Weight:*

Gender:*

Male Female

Team Captain Information

E-Mail:*
Valid e-mail is required

Phone:*

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

DISCLAIMER AND LIABILITY RELEASE

I accept any and all responsibility for, and assume the risk of, any and all injury or damage to myself and my team
if you are a captain or team leader I, we or they while are participating in the Lake Havasu Boat Races during any
practices or any events that take place as part of the Lake Havasu Boat races. I hereby expressly release,
discharge and hold harmless from any liability whatsoever any of the Lake Havasu Boat Team, Race Committee
and their members and the City of Lake Havasu or any associate sponsors. This also includes any other sponsors
and individuals and helpers whether salaried or voluntary. I certify that I have read, understood the contents of the
liability release and disclaimer and that it is my intention, by signing this form that it is binding not only upon me
but also upon my heirs, executors, administrators, successors and assigns.

Credit/Debit Card Information

Card Number:*
No dashes or spaces please

Expiration Month:*

Expiration Year:*

Card Brand:*

Your Team Captain is responsible for each of their participants. Therefore, this release MUST also be signed.

Team Captain Signature:*

Dated*

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