REGISTRATION New Jersey Firefighters 23rd Annual Ski Race Friday February 26, 2010 Pre-Registration $60.00per person/$300.00 per tm Day of Race $70per person/$350 per tm Department Name/Town ______________________________________________________ Address____________________________________________________________________ Telephone __________________________Unit# __________________________________ Is this an address change? __ Yes __ No Email _________________________________ PRINT NAME SIGNATURE 1. ______________________________ ________________________________ 2. ______________________________ ________________________________ 3. ______________________________ ________________________________ 4. ______________________________ ________________________________ 5. ______________________________ ________________________________ In consideration of your accepting this entry, I hereby, for myself, my heirs, executors and administrators, waive and release any rights and claims for damages I may have against the New Jersey Firefighters Ski Race committee, their spouses, their representatives and successors, and Hidden Valley Ski Area for any and all injuries suffered by me or personal damage incurred in connection with said event. I certify that I am physically fit and have sufficiently trained for the completion of this race. I also give permission for the use of my name and/or picture in any newspaper, broadcast, telecast or any other account of this event. PLEASE ENCLOSE FULL FEE OR MINIMUM $100 DEPOSIT WITH COMPLETED FORM. MAKE CHECKS PAYABLE TO: NJFF SKI RACE MAIL TO ARRIVE BEFORE: February 17, 2010 TO: Mark Ellerson 20 Long Acre, Cream Ridge, NJ 08514 EMAIL: NFFSKIRACE@AOL.COM, CCCHERYLD @ AOL.COM