Please fill out/print this form and mail with payment (certified cheque or money order only) to: Percy DeWolfe Race, Box 133, Dawson City, Yukon, Canada, Y0B 1G0

NAME:

SIN#/SOC.SEC#:

DATE OF BIRTH:

DAY >

MONTH >

YEAR >

(REQUIRED FOR CUSTOMS CLEARANCE FOR THE PERCY RACE ONLY)

CITIZENSHIP:

U.S. DRIVER'S LICENSE # (if have one):

LANDED IMMIGRANT STATUS (if applicable):

PASSPORT NUMBER IF FROM OUTSIDE USA OR CANADA:

ADDRESS:

AGE:

PHONE:

EMAIL:

WAIVER - I hereby acknowledge that I enter the above race(s) at my own risk, and that no Director, Officer or Employee of the Percy DeWolfe Memorial Mail Race Cornmittee shall be liable for injury or damage to my person or property, or to the person or property of others, arising out of my entry and participation, and I agree to indemnify the Percy DeWolfe Memorial Mail Race Committee against claims thereof.

MUSHER'S SIGNATURE: ______________________________________________________

AGE: All entrants must be 16 years of age as of March 16/2008 . Those entrants between 16 and 18 years of age, must have their parent's or legal guardian's signature below. The undersigned parent or legal guardian of the entrant agrees that no Director, Officer or Employee of the Percy DeWolfe Memorial Mail Race Comrnittee shall be liable for injury or damage to my person or property, or to the person or property of others, arising out of my entry and participation, and I agree to indemnify the Percy DeWolfe Memorial Mail Race Committee against claims thereof.

PARENT'S OR GUARDIAN'S SIGNATURE: ____________________________________________

Publicity Sheet ( Info to announce at start of race for spectators)

ONE FORM PER MUSHER

Percy Entry Fee: $250 (prior to March 01/08 or $300 on or after March 01/08) Percy Jr. fee: $75
Certified cheque/money order only or Pay securely online with your credit card here.

FAMILY:

RACING HISTORY:

SPONSORS:

GOALS:

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