REGISTRATION FORM
Make Check or money order payable to "Run Your Bass Off"

Age on Race Day ____ Sex ___ U.P.R.R.___                                                                                                                                                                                                                   SELECT ONE OF THE 4 RACES
                                                                                                                   
NAME: ________________________________              1. _____10k        2.  _____ Half Bass

                                                                                                        3.  Clydesdale [Half Bass Only]
ADDRESS:_____________________________               __ Male [190+lbs]    ____Female[150+lbs]

CITY:___________________ST____ZIP_______         4. ______ 2 Mile Walker (noncompetitive)

Please read the following statement.  Sign below before submitting entry:
In consideration of acceptance of my entry, I hereby waive and release any of the sponsoring groups, officials, attendants, any and all other persons for any and all injuries suffered by me at said "Run Your Bass Off"  Road Race.  I attest and verify that I am physically fit and sufficiently trained for the completion of this event.  Further, I hereby grant permission for use of my name and any photographs or other records of my participation in this event for any publicity, without obligation or liability to me.

Signature:__________________________________Parent/Guardian_______________________

MAIL FORM TO:
                                      Run Your Bass Off"
                            c/o Crystal Falls Business Association
                            P. O. Box 233
                             Crystal Falls, MI  49920