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Embed code for: P4 registration form 2016
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It’s Time Again for the P4! Ready, Set, Go for Madeline Island’s 13th Annual “Quadrathon!” Pedal, Paddle, Plod & Plunge! Saturday, July 2, 2016 Now in it’s 13th year, the P4 is a fun event that can be done individually or as a team! Starting at Joni’s Beach the first “P” is an 11-mile pedal. The second “P” is a 4- mile paddle (sorry, no rowing!). The third “P” is a 4-mile plod and the final “P” is a plunge into Lake Superior for individuals, or a 250-yard swim for teams. Start time: 9:30am at Joni’s Beach. Fees: $25.00 per participant in advance or $ 30.00 day of event ($10.00 discount for students). Registration is limited to 80 participants. Includes t-shirt and post-race picnic. An approved bicycle helmet is required. An approved PFD is also required wear while kayaking. For more information please contact us at firstname.lastname@example.org or stop by the Madeline Island Chamber of Commerce Please complete one form per person and mail with fees made payable to: Madeline Island Chamber of Commerce, P.O. Box 274, La Pointe, WI 54850 Name_______________________________________________________________ Age_____________ Address______________________________________________________________________ City/State/Zip__________________________________________________________________ Phone: ________________________________________Email:________________________ Individual ________ Team________ I plan to (circle all that apply): Bike Kayak Run Swim Team name/members: _____________________________________________________________________ ______________________________________________________________________________ (Each member must complete separate form) RELEASE: In consideration of my participation in the Pedal Paddle Run and Plunge event, I __________________________, on behalf of myself, my heirs, legatees, personal representatives, and all those claiming by or through me, consent to, and do hereby, discharge and release and forever hold harmless the Madeline Island Chamber of Commerce, and all sponsors of this event their affiliates, agents, servants, employees, assigns, successors, and heirs from any and all claims, actions, losses, damages, or expenses for personal or bodily injury (including death) and property loss or damage of whatever the nature or cause, incurred by me arising out of or any way in conjunction with my participation in the aforementioned event to be held on July 2, 2016. ______________________________________________________________________________ Signature of participant __________________________________ (Parent/legal guardian for those under 18)_________________________________ Date_______________________ T-Shirt size: Circle one: S M L XL – Every effort will be made to get you the correct size. No guarantee for day-of registrants. Additional t-shirts may be available for $15.00 on the day of the event. Participants are required to provide their own bicycle and kayak. Bikes may be rented from Motion to Go (715.747.6585). Kayaks are available to rent from Apostle Islands Kayaks (715.747.3636). Should severe weather be imminent, the race start will be delayed for 2 hours (11:30AM) at which time a determination whether the event can safely be run on the scheduled date will be made. I understand that my registration fee is nonrefundable. If the event is canceled by the Madeline Island Chamber of Commerce (MICC) due to circumstances beyond their reasonable control such as extreme and potentially dangerous weather or course conditions, or as the result of governmental action, the MICC may not refund my registration fees. Any accommodations in such an event will be made at the sole discretion of the MICC. Madeline Island Across the Bay – A World Away! www.madelineisland.com