Generic XC Application (Good for all races)

The Name of the Race you are entering ____________________________________  Date _________
Pre-Reg Fee Enclosed ___________  Check # ________	official use only
Race Day Fee __________     D.O.B. ____/____/____           Age:  ______
Entrants Name ________________________________________________________     Sex:  __ M    __ F
PLEASE print your name clearly and use the same last name as used on your PAUSATF membership.
Address __________________________________________________ Email: ____________________
City _______________________________________  State ____  Zip ________
Phone (Day) ___________________   (Eve) ___________________
PACIFIC ASSOCIATION RUNNERS (Write in association if other than Pacific) PA/USATF Club Name ________________________________________ Club Number ______ WAIVER: (The following must be signed to enter the race. If you are under 18, your parent or guardian must sign for you.) In consideration of your accepting my entry, I, intending to be legally bound, do hereby for myself, my heirs, executors and administrators waive and release forever any and all rights and claims or damages I may accrue against any and all organizations, sponsors, and/or individuals connected with this event, their representatives, successors and assigns for any and all injuries suffered by me in connection with this event including pre and post race activities. Signature ___________________________________ Date:______________

For race registration mailing addresses, see detailed Cross Country Schedule for each individual event.