In consideration of acceptance of this entry, I the undersigned intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against HI-TEK Racing, Nichols Improvement Association, the race director and officials, the Town of Trumbull, their representatives, any and all race sponsors and supporters, volunteers, their agents, successors and assigns, for any and all injuries suffered by me in said event. I assume all risks with entering this event, including but not limited to falls, contact with other participants, effects of weather, including high heat and humidity, extreme cold or wind, traffic and the condition of the road. All such risks being known and appreciated by me. I attest and verify that I am physically fit and sufficiently trained for the completion of this event. Further, I hereby grant full permission to any and all the foregoing to use my photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purposes without compensation or remuneration.
PRINT OUT THIS APPLICATION AND MAIL WITH CHECK
LAST NAME: ___________________________________ FIRST NAME: ____________________________ ADDRESS:___________________________________________________ CITY: _________________________________ STATE: ________ ZIP: _________ SEX: ______ DOB ____________ AGE ON RACE DAY: _______________
TELEPHONE: ___________________________ EMAIL: ___________________________________
T SHIRT: S M L XL
SIGNATURE: ____________________________________________
(parent or guradian must sign if under 18)
Entry Fees: $17.00 By December 4th - $20 After and on race day
Make check payable and mail with application to:
Nichols Improvement Association
C/O HI-TEK Racing
#183 - 7365 Main Street
Stratford, CT 06614