BELIKIN La Ruta Maya Belize River Challenge Team Registration Form

TEAM SPONSOR*
ADDRESS*
CONTACT PERSON*
TELEPHONE*
EMAIL*
example@example.com
ENTRY CATEGORY*

MALEFEMALEMIXEDMASTERSINTERMURALPLEASUREC2FAMILY ADVENTURE
Team Members
Team Captain*

First NameLast Name
Age*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Team Member 2*

First NameLast Name
Age*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Team Member 3*

First NameLast Name
Age*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Team Name*
Fully completed and signed registration forms with entrance fee may be mailed or delivered to:

Love FM, 7145 Slaughterhouse Road or Yoli's Pizza in San Ignacio.

Payment can also be made via Love Entertainment Atlantic Bank Account # 100 126329 For further information call: JULIA CARRILLO at 621-1955

**All TIMING CHIPS ASSIGNED MUST BE RETURNED OR A REPLACEMENT FEE OF $100 WILL BE CHARGED**

In consideration of being permitted to participate in the 2025 BELIKIN La Ruta Maya Belize River Challenge and to compete for prizes, each participant and team sponsor hereby agrees that neither the team sponsors, nor the event sponsors or promoters, nor any other person or entity connected with the BELIKIN La Ruta
Maya Belize River Challenge is responsible to them for any injury to themselves or damage to their property as a result of their participation in the event and that they specifically waive any such claim and fully release said persons from any such liability or claims. In addition, all participants hereby agree to abide by all of the
competition rules and regulations as set forth by the La Ruta Maya Belize River Challenge Competition Committee.

****SEE COMPETITION RACE RULES FOR DIVISION RESTRICTIONS***
Team Captain's Signature

Clear
Date

MonthDayYear
Date
Signature 2

Clear
Date

MonthDayYear
Date
Signature 3

Clear
Date

MonthDayYear
Date
*REGISTRATION FEE IS $300.00 BZ. PER TEAM** (FEE covers a daily lunch per paddler)
Date Paid

MonthDayYear
Date
Cash
Cheque #
Deposit
Upload Proof of Payment (e.g., deposit slip, payment receipt)

Cancelof
Prizes payable to*
PLEASE NOTE THAT WHATEVER NAME IS LISTED ABOVE IS WHO PAYMENT WILL BE MADE TO
Should be Empty:

Team Members