Manastash Metric

Registration

Name: ______________________________________________________

Address: ____________________________________________________

City/State/Zip: ________________________________________________

Phone: ______________________________________________________

Email: _______________________________________________________

Pre-Registration: $15.00 ($20.00 tandem)
Day-of-Tour: $20.00 ($25.00 tandem)

T-Shirt: $15.00, Specify Size (S,M,L,XL):
Order by September 1^st to guarantee delivery on day of ride

Make Checks Payable to: United Way of Kittitas County
or
Payment by Credit Card (circle one) Visa, MC, AMEX

Card Number______________________________________

Exp date___________________ *Security Code__________

Signature _____________________________ Date_______
*security code is the last three digits on signature block

Mail to:
P.O. Box 483
Ellensburg, WA 98926

Waiver for Participation

In consideration of your accepting my child's or my entry, I hereby consent to participation in the herein described activity by the person name herein, and hereby waive any and all claims against and agree to hold blameless the United Way , their agents and/or employees from any and all claims which may be made for damages and injury to property or any person arising as a result of, or in connection with, such participation by me or said child occasioned by any cause whatsoever, including, but not limited to, negligence by the City of Ellensburg, City of Cle Elum, Kittitas County, or the United Way or any of their agents and/or members.

Signature: ___________________________________ Date: _____________

Emergency Contact Information

Name: ______________________________________________________

Address: ____________________________________________________

City/State/Zip: ________________________________________________

Phone: ______________________________________________________