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Saturday, July 15, 2000 -- Hopedale, OH
Mickey's Duathlon

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NAME: _______________________________  AGE: ____  SEX: ____

ADDRESS: ____________________________

CITY: _______________  STATE: _______  ZIP: __________

PHONE: (_____) _____ - _______  T-SHIRT SIZE: ______

ENTRY FEE CIRCLE:  INDIVIDUAL $25  or  TEAM $30
Waiver: please read and sign below I fully understand and assume all risks (heat exhaustion, personal injury, bicycle falls, contact with other participants and conditions of the course, etc.) involved in participating in the duathlon and represent that I am physically fit and sufficiently trained to participate in this event. I also understand that it is my responsibility to know and follow all rules relating to bicycling on the trails. I, for myself, and anyone entitled to act on my behalf waive and release the Mickeys, volunteers, directors, agents, and co-sponsors from and against any and all actions, claims, demands or damages which in any way arise out of or result from my participating in the duathlon. I further agree you may use my name and any picture of my participation in the duathlon, for publicity and/or promotional purposes, without any obligation or liability to me. I am aware that it is my responsibility to have my own health insurance. I have carefully read and understand the foregoing Waiver and that I am signing it of my own free will.

Signature: ____________________________________________ Date: ____________

Mail to:
Calvin Mickey
88233 Mickey Rd.
Hopedale, OH 43976