TRINIDAD TO CLAM BEACH Entry Form
Saturday, January 28, 2017
Trinidad, California
Half Marathon (NEW in 2017); 8-3/4 Mile; 5-3/4 Mile; 3-Mile

www.trinidadtoclambeach.com

Official Use Only

Instructions
> Type in your information in the blanks provided.
> Print entry form & SIGN WAIVER (Entry will not be accepted without the signed waiver)
> Make Checks Payable to:
Trinidad to Clam Beach

Mail to:
Trinidad Chamber
PO Box 356
Trinidad, CA 95570


Event (Choose One) - (entry fee includes T-shirt)
NOTE: Family Rate does not apply to Half Marathon rates, and is only valid for early registration (race weekend registration excluded). Rate is $30 per person if 4 or more family members register together.

First Name / MI / Last Name


Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy

Age

Gender

Phone

Email

Division (Individual)

Regular T-Shirt OR Tech Shirt - Select Size/Type in menu below (included with race entry fee)

Check#

Amount Enclosed


WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
WAIVER & RELEASE: READ THIS! I know that running/walking a road race is a potentially hazardous activity. I should not enter and run/walk unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run/walk. I assume all risks associated with participating in this event including, but not limited to falls, contact with other participants, the effects of weather, including high humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of acceptance of my entry, I for myself and anyone entitled to act on my behalf, waive and release any and all persons, sponsors and entities, their representatives and successors from all claims or liabilities of any kind arising out of my participation even though said liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission for all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. Parents must sign if participant is under 18 years of age. This is to certify that my child has permission to complete in this event, is in good physical condition and that event officials may authorize necessary emergency treatment. I agree to return the Timing Chip assigned to me or pay a $30.00 replacement fee. ENTRY FEES ARE NON-REFUNDABLE.

Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________