MINNESOTA HUMAN POWERED VEHICLE ASSOCIATION

17th ANNUAL HUMAN POWERED ICE RACES

SATURDAY JANUARY 26, 2008

OFFICIAL ENTRY FORM 

  Please print or type and fill out the form completely.

 

Vehicle Name  __________________________________________

                 (Warning: If you don't come up with one, we will.  Remember Luke Breen's "Yellow Snow"?)

 

Vehicle Number ___________     _____________         _______________

                                       1st choice                     2nd Choice                               3rd Choice

 

Owner/Builder_______________________________________________

 

Rider (if not same)____________________________________________

 

Age_______Address______________________________________________

 

City_____________________________ State_______ Zip________________

 

Phone #s  home:(______)_____-________  work:(______)______-__________

 

Email Address ____________________________________________________    

 

         Vehicle Class:  (check one)                            Races Entering

_____Rubber Only                                           _____100-meter Time Trial

_____Traction Aided   (Studs, skates etc.)       _____Drag Race                     

                                                            _____Circuit Race                                                                                                                                                      

MnHPVA Member?     Y    N                    IHPVA Member?     Y    N

 

Waiver

Racing is an inherently dangerous sport by it's nature, and
an event entirely on ice holds added danger of injury and or damage to property.
Understanding these potential hazards I hereby agree to hold blameless the
Minnesota Human Powered Vehicle Association, it's agents and officers, and any
entity that it contracts with in conjunction with this event, for any injury or
loss of property that I may sustain while in or near the races, or on the lake
where the event is held. My signature below certifies that I understand and
agree to abide by this as well as all race rules and procedures.

 

Signed: __________________________________ Date: ___________________

For any participant under 18 years of age a signature of a parent or guardian is required.

Parent/ 

Guardian: ________________________________ Date: ___________________