Tremont Turkey Festival Bed Race

June 11, 2011, 1 p.m.

Team Name ________________________________________


CONTACT PERSON:

Name    __________________________________________

Address _____________________________________________________

City    _______________________  State ___  Zip Code ________

Phone   _______________________

   

EACH PARTICIPANT PLEASE PRINT NAME AND SIGN BELOW:
(Guardian or parent's signature if participant is under 18)

I warrant that I am physically fit enough to participate in this event and have done proper training. In consideration of my entry, I, intending to be legally bound for myself, my heirs, executors and administrators, waive and discharge any rights and claims against the Tremont Turkey Festival Committee, the Town of Tremont, the Race Committee and/or any other individual or groups involved with the running of this event for any or all injuries suffered by me at this event or while traveling to and from the event.

                    PRINT NAME                   SIGNATURE             DATE

Rider     ____________________________ ____________________________ __________

Pusher #1 ____________________________ ____________________________ __________

Pusher #2 ____________________________ ____________________________ __________

Pusher #3 ____________________________ ____________________________ __________

Pusher #4 ____________________________ ____________________________ __________

Please make your $10 check payable to Tremont Turkey Festival Committee and mail it with this completed form to:

Bruce McWilliams
513 N. Locust Street
Tremont, IL 61568

Entries must be received by June 6, 2011