PLEASE PRINT

Name ______________________________________Birth date ________________ Age______________

Address_______________________________________________________________________________

City_______________ State ______Zip ____________Michigan Cup Team________________________

Phone (____)_________________ Gender_________ E-Mail address _____________________________

 

Circle skier age. Classification as of January 1, 2004                                               

13-19 yrs                      40-49 yrs                70-79 yrs                                                Entry fee by February 1…………$15

20-29 yrs                 50-59 yrs                80+ yrs                                                   Entry fee by March 1……………$20

30-39 yrs                60-69 yrs                                                                                March 1-6……………………….$25

                                               

T Shirt Size:     S        M        L        XL       (T Shirts guaranteed with registrations prior to Feb. 25. First come,

                                                                                first serve after that).

 

I enclose $ ____________ for entry to the Black Mountain Nordic Classic Ski Race. My cancelled check will

serve as my receipt (please do not send cash). Money orders or checks should be made payable to:

The Presque Isle County Tourism Council

 

RELEASE OF LIABILITY:  I, the undersigned, know that Nordic skiing is an action sport carrying

significant risk of personal injury, including, for example, over-exertion, exposure, and injuries from

 falling and/or colliding with various objects, including snowmobiles, trees and other participants, at

high rates of speed. I am participating voluntarily and know that there are natural and man-made obstacles

or hazards, surface and environmental conditions and risks, which in combination with my participation

and actions, can cause very severe or occasionally fatal injury.  I agree that I, not the ski race, its staff,

ski clubs, officials, sponsors, aid workers, volunteers or trail groomers, am exclusively and completely

responsible for my safety while I participate in or train for this event. I assume all risks of injury. 

 

(Parental signature for applicants under 18).

 

Signature__________________________________________  Date______________________________

 

Send to:

 

Black Mountain Nordic Classic

Presque Isle County Tourism Council

658 South Bradley Hwy.

Rogers City, MI 49779

989-734-4722 or 888-854-9700    Fax: 989-734-2577    Email: [email protected]