Date: Sunday, October 17th, 2010

Start Time: 10:00 am at end of Rio Vista Street (across Bridge St.) in Springville

Registration:  Adults $40.00;  Kids are Free!

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Name (Please print): _________________________________________________________

Address: __________________________________________________________________

City/State/Zip: ______________________________________________________________

Phone Number: ________________________

Email Address:  _______________________________

Date of Birth: __________________________

Gender (Circle one): Male or Female

Class: (Circle one):

Age (Circle one):

T-shirt Size (Circle one):

*All participants must sign a waiver and wear a helmet which meets or exceeds ANSI or Snell standards.

Full Waiver & Release

In consideration for my entry being accepted, I hereby waive and release forever for myself and for my heirs, executors, administrators, any and all claims, causes of actions and suits including wrongful death, that I may accrue against the Springville Community Club,  Springville, County of Tulare, property owners on whose property the race is run, race director, race volunteers and any donors or sponsors of this race for any bodily injury, emotional injury, property damage or economic loss, including death, suffered by me while traveling to and from or competing in the Springville Fat Tire Classic Race or Kids Race on October 17th, 2010 whether from natural hazards, human-made hazards, actions or inactions of third parties, or any other defect or omission or act.

Signature of participant:

Signature of parent or guardian for minors:

Date:  ________________________