MAKE CHECKS PAYABLE TO:
Maysville Public Library -WPSRR|
PO Box 878
Maysville, OK 73057
Pre-Registration (Before June 1st) $15.00 __________
Late Registration(After June 1st) $20.00 __________
Total Amount Enclosed:***$_________
Name:_________________________________________________________________
Address: _______________________________________________________________
City:___________________________________ State:____________ Zip:____________
Phone: _________________________ E-Mail:__________________________________
Circle Distance: 30 40 52
T-Shirt Size: S M L XL
$1.00 extra for XXL
In consideration of the acceptance of this registration entry, I, the undersigned, assume full and complete responsibility for any injury or accident which may occur during my participation in this WPSRR, and I hereby release and hold harmless the sponsors, promoters and all other persons and entities associated with this event from any and all injury or damage, whether it be caused by negligence or the sponsors, promoters or other persons or entities associated with the event.
________________________________________ Date______________
Rider's signature
________________________________________ Date ______________
If rider is under 18, must have guardian's signature.