THE 2010 GREAT PORT TOWNSEND BAY KINETIC SCULPTURE RACE RACERS ENTRY FORMS

WHO ARE YOU?

SCULPTURE NAME:____________________________________________________________________________

WHO'S IN CHARGE?

PILOT NAME:__________________________________________________________________________________

WHERE CAN WE FIND YOU? STREET:___________________________________________________________

CITY:__________________________________ STATE:____________ ZIP:________________________________

CAN WE TALK?

PHONE:_________________________________EMAIL:_______________________________________________

ADDITIONAL PILOT(S)

NAME(S):______________________________________________________________________________________

PIT CREW NAMES:_____________________________________________________________________________

ALL PILOTS AND PIT KREW MUST INCLUDE SIGNED WAIVER WITH REGISTRATION

FROM THE RACE COMMITTEE. NO EXCEPTIONS. Notarized permission statement signed by

Legal Guardian (SEE WAIVER) must be included for all minors.

LIST NAMES AND AGES OF THOSE UNDER 18:

________________________________________________________________________________________________

ANYONE PUT YOU UP TO THIS?

SPONSORED BY:_______________________________________________________________________________

DOES YOUR MOTHER KNOW?__________________

BEEN HERE BEFORE?

ANY AWARDS WON?___________________________________________________________________________

PER PILOT.#OF PILOTS=SEATS ON THE SCULPTURE.

SCULPTURE WITH ONE PILOT...$20.10

ADDITIONAL PILOTS ON SKULPTURE...$10.10

LATE REGISTRATION FEE OF $15.00 FOR ALL ENTRIES AFTER 9/24/2010

LATE ENTRIES WILL NOT RECEIVE PILOTS SHIRT

MAKE CHECKS PAYABLE TO:

PT. TOWNSEND KINETIC SCULPTURE RACE (PTKSR)

P.O. BOX 451, PORT TOWNSEND, WA 98368

FOR INFO CALL: HIGH PRIESTESS JANET AT HOME: (360) 385-3741 OR

CALL KINETIC KOFFEE (360)379-4972

One Pilot x $20.10

# Additional Co-Pilots _________ x $10.10= ______

WAIVER OF ALL RESPONSIBILITY

NAME OF SCULPTURE:___________________________________________________________

I desire to participate in the 2009 GREAT PORT TOWNSEND BAY KINETIC SCULPTURE

RACE. For this opportunity to participate, I agree to the following;

1. I understand that the sponsors and organizers of the race have laid out a proposed race

course and made suggestions regarding equipment, race vehicles, etc., but that they do

not, in any way, guarantee or warrant the safety of the course or any vehicle.

2. I assume, for myself and crew, full and complete responsibility for the course covered by

me and/or my vehicle during the race and for the construction, equipping and condition

of my vehicle or the vehicle with which I participate.

3. I specifically waive, as to the sponsors and organizers of said race, any and all complaints

and causes of action of any kind, whether from negligence, contract, warranty or

whatever cause.

4.I have read the "OFFISHUL RULES".

4a. I understand the rules.

All participants, both Pilots and Crews must sign and date below. Participants under the age of 18

must have this waiver notarized and signed by a legal guardian (see below)

_____________________________________ ____________________________________

_____________________________________ ____________________________________

_____________________________________ ____________________________________

Signed under penalty of perjury this _________day of ___________________, 2009.

If participant is under 18 years of age, authorized parent(s) must sign below: I have read the above

statement and agree to its terms and conditions on behalf of myself and my son or daughter. (If you

have more then one minor a reproduction of this waiver is acceptable with the proper Notary Seal

Affixed.)

_______________________________________________________

Minors Name

Signed under penalty of perjury this ___________ day of______________, 2009

at ________________________________, __________________________,___________________

Town County State

_______________________________________, _________________________________________

Legal Guardian Legal Guardian

NOTARIZED SIGNATURE

REQUIRED FROM AUTHORIZED

PARENT OR GUARDIAN OF

PERSONS UNDER 18 YEARS OF AGE