Last Name/First Name

USSA # and Division

Age of of 3/12/06 (race day) and date of birth

Gender (circle one):   Male       Female

Race (circle one)

   26km classic       26km freestyle         50km freestyle

Event and date

   Great Bear Chase, March 12, 2005

2006 Fees

$45 by December 30; $50 by February 11; $55 by March 10; $60 on March 11

No registration on the day of the event

Age classes:

26-km Classic: 13-19, 20-29, 30-39, 40-49, 50-59,
60-69, 70+

26-km Freestyle: 13-15, 16-17, 18-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+

50-km Freestyle: 18-24, 25-29, 30-34, 35-39, 40-44, 45-49,
50-54, 55-59, 60-64, 65-69, 70+

Notice: Send this entry form directly to the race organizer. Entry forms without entry fees will be discarded. Send your entry and fees at least five days before the event.

Signing this form indicates agreement to the conditions outlined below. You must sign this form to participate in a USSA corss-country event. If you do not accept fully the conditions below do not complete, officiate, coach or in any other way participate in any eventI, the undersigned, know that Alpine and Nordic Skiing are action sports carrying significant risk of personal injury. Racing, jumping, or freestyle competition is even more dangerous. I know that there are natural and man-made obstacles or hazards, surface and environmental conditions, and risks which in combination with my actions ca cause me very severe or occasionally fatal injury. I agree that I, as a paraticipant, must take an active role in understanding and accepting these risks, conditions and hazards. I also agree that I, and not the ski area or its staff or the sponsor of USSA (USSEF, USST and USSCA) and/or its slubc, officlas and staff, am responsble for my safety while I participate or trail for these events.

Organizers and racers please note: This statement of risk, and the signatures thereto, shall be valid for all single competitions of this meet. This meet includes all competitions staged by this organization at this site in a contiguous period of time, and acceptance of the risk applies to all of the competitions of this meet.

Signature:____________________________________________________

Parent or guardian (if under 21) __________________________________

Date: _____________________________________________