Form

2013 Canadian Death Race - Team Registration - sample ("submit" button removed)
Team Info

MAKE SURE OF YOUR TEAM NAME AND SIZE. NO CHANGES WILL SUBSEQUENTLY BE ALLOWED TO THE TEAM NAME AND SIZE UNDER ANY CIRCUMSTANCES. When entering data into all fields of the form, use proper case (ie "John Doe", not "john doe" nor "JOHN DOE"). Fields with a red asterix must be completed before the form can be submitted. ONLY ONE FORM IS TO BE SUBMITTED PER TEAM BY THE TEAM CAPTAIN.
TeamName*
TeamSize*
5 Person Team Registration $1,750.00 CAD
4 Person Team Registration $1,400.00 CAD
3 Person Team Registration $1,050.00 CAD
2 Person Team Registration $700.00 CAD
Team Captain
CaptainName*
First Name Middle Name Last Name

Address*

HomePhone*
WorkPhone
CellPhone
Email*
Racer #1 (R1)

This is not necessarily in order of leg assignment.
Name R1*
First Name Last Name
Gender R1*
AgeCategory R1*
on Race Day
Tshirt R1*
Email R1*
HomePhone R1*
CellPhone R1
City R1*
State/Province R1
Country R1*
EmergencyContact R1*
Please enter name AND telephone #
Medical R1
Is there a significant medical problem?
MedProblem R1

Please describe the problem here if you would like to share that with us. 0/200
Biography R1

Tell us a little about this racer. 200 character limit. 0/200

R1 Prior Races Attended

	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011
.

Racer #2 (R2)

This is not necessarily in order of leg assignment.
Name R2*
First Name Last Name
Gender R2*
AgeCategory R2*
on Race Day
Tshirt R2*
Email R2*
HomePhone R2*
CellPhone R2
City R2*
State/Province R2
Country R2*
EmergencyContact R2*
Please enter name AND telephone #
Medical R2
Is there a significant medical problem?
MedProblem R2

Please describe the problem here if you would like to share that with us. 0/200
Biography R2

Tell us a little about this racer. 200 character limit. 0/200

R2 Prior Races Attended

	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011
.

Racer #3 (R3)

This is not necessarily in order of leg assignment. Data fields will only appear for Racer #3 if a 3, 4 or 5 person team was selected above.
Name R3*
First Name Last Name
Gender R3*
AgeCategory R3*
on Race Day
Tshirt R3*
Email R3*
HomePhone R3*
CellPhone R3
City R3*
State/Province R3
Country R3*
EmergencyContact R3*
Please enter name AND telephone #
Medical R3
Is there a significant medical problem?
MedProblem R3

Please describe the problem here if you would like to share that with us. 0/200
Biography R3

Tell us a little about this racer. 200 character limit. 0/200

R3 Prior Races Attended

	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011
.

Racer #4 (R4)

This is not necessarily in order of leg assignment. Data fields will only appear for Racer #4 if a 4 or 5 person team was selected above.
Name R4*
First Name Last Name
Gender R4*
AgeCategory R4*
on Race Day
Tshirt R4*
Email R4*
HomePhone R4*
CellPhone R4
City R4*
State/Province R4
Country R4*
EmergencyContact R4*
Please enter name AND telephone #
Medical R4
Is there a significant medical problem?
MedProblem R4

Please describe the problem here if you would like to share that with us. 0/200
Biography R4

Tell us a little about this racer. 200 character limit. 0/200

R4 Prior Races Attended

	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011
.

Racer #5 (R5)

This is not necessarily in order of leg assignment. Data fields will only appear for Racer #5 if a 5 person team was selected above.
Name R5*
First Name Last Name
Gender R5*
AgeCategory R5*
on Race Day
Tshirt R5*
Email R5*
HomePhone R5*
CellPhone R5
City R5*
State/Province R5
Country R5*
EmergencyContact R5*
Please enter name AND telephone #
Medical R5
Is there a significant medical problem?
MedProblem R5

Please describe the problem here if you would like to share that with us. 0/200
Biography R5

Tell us a little about this racer. 200 character limit. 0/200

R5 Prior Races Attended

	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011
.

Team Leg Assignments

Please get the spelling correct (matching the Racers Names entered above).

Leg Assignments*

	Leg1	Leg2	Leg3	Leg4	Leg5
First Name
Last Name

Once you submit this form you will be directed to pay through Paypal. 5% GST will be added to your purchase.
Consent*

I, as the Team Captain, agree to all the risks of participating in the race, up to and including death and that I and my team-mates have read and agree to the Waiver of Laibility (www.canadiandeathrace.com/waiver). I also understand that there are no refunds. AS TEAM CAPTAIN, I (or delegate) MUST BRING MY ENTIRE TEAM'S SIGNED WAIVERS WITH ME FRIDAY OF RACE DAY WEEKEND TO PICK UP OUR TEAM RACE KIT.
Should be Empty:

2013 Canadian Death Race - Team Registration - sample ("submit" button removed)