2013 Canadian Death Race - Team Registration

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
prevnext( X )
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 NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
HomePhone
WorkPhone
CellPhone
Email
Racer #1 (R1)

This is not necessarily in order of leg assignment.
Name R1

First NameLast 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

Rows	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 NameLast 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

Rows	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 NameLast 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

Rows	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 NameLast 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

Rows	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 NameLast 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

Rows	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

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)