www.islandtoislandwatermanrelay.com Island to Island Waterman Relay Race Entry Form October 11, 2014 Santa Barbara Island to Isthmus, Catalina Island Please Circle Your Team Class: SUP 14’ – Stock Paddleboard – Unlimited Paddleboard TEAM NAME: _________________________________ OC 1’s – Surf Ski Escort Vessel Name (Captains admission fee is included): ____________________________________________ Teams of 3: (Please print legibly) Name _________________________ ________________________ _________________________ Address _________________________ ________________________ _________________________ City _________________________ ________________________ _________________________ State & Zip _________________________ ________________________ _________________________ Country _________________________ ________________________ _________________________ Phone _________________________ ________________________ _________________________ Age _________________________ ________________________ _________________________ Email _________________________ ________________________ _________________________ Please Circle Size: Complimentary T-Shirt: L XL XXL Additional T-Shirts available $15 L XL XXL $300 Entry Fee Includes (After September 15, the entry fee will be $325): • 3:30pm Show • 5:45pm Dinner & Raffle • 6:45pm Awards Presentation • 8:00pm Finish Additional dinner tickets may be purchased at event, $65 per adult & $25 per child 12 and under. Liability Waiver. You must read and sign to participate : (Entrants must be 18 years of age or older): In consideration of my entry in the Island to Island Waterman Relay Race held on October 11, 2014, I for myself, my heirs, executors, administrators, and assigns, waive and release any and all rights and claims for negligence I may have or accrue against the County of Ventura, County of Los Angeles, the City of Los Angles, Catalina Island, Santa Barbara Island, Lifeguard Services, Giles D. Finlayson, and any other race sponsors or co-sponsors or their representatives, agents, successors, and assigns for any and all damages or injuries or death which may be suffered as a result of my participation in this event. I attest and verify that I am physically fit and sufficiently trained for the competition of this race. I am completely and solely responsible for my own safety. I understand that the race will be covered using general photographic, film, and/or digital video cameras and may be televised. By signing this entry, I release all rights or propriety claims for the use of my image or voice to be photographed, videotaped or filmed for commercial or any other purposes. I authorize the unconditional use of my image or voice in any form while participating in this event. I confirm that I am 18 years of age of older . ____________________________________ Participant Signature _________________________ Date ____________________________________ Participant Signature _________________________ Date ____________________________________ Participant Signature _________________________ Date Please mail completed entry form and check to (make checks payable to Island to Island Waterman Relay): Island to Island Waterman Relay Race - c/o Giles Finlayson • 1810 Parliament, Encinitas, CA. 92024 760.436.5928