Adirondack Watershed Alliance
PO Box 111 Paul Smiths, NY 12970 (518) – 891 – 2744
Hamilton County Invitational C-4 Challenge
Location: Indian Lake
Distance:10 miles
Registration Time:8:00 - 9:30
Start Time:10:00
Entry Fee: $30 pp for Amateur paddlers, $25 for AWA members, $50 pp for C-4 Pro Stock
Paddler 1: Paddler 2:
Name: __________________________________Name: ________________________________
Address: ________________________________Address: _________________________________
______________________________________ _________________________________
Home phone: ___________________Age: ____ Home phone: _______________ Age: _____
Email Address :____________________________Email Address: __________________________
Paddler 3: Paddler 4:
Name: __________________________________Name: ________________________________
Address: ________________________________Address: _________________________________
______________________________________ _________________________________
Home phone: ___________________Age: ____ Home phone: _______________ Age: _____
Email Address :____________________________Email Address: __________________________
ARE YOU A MEMBER OF AWA? YES NO ~~ ARE YOU A MEMBER OF NYMCRA? YES NO
PLEASE CIRCLE YOUR AGE CATEGORY UNDER 50 50 PLUS
PLEASE CIRCLE YOUR GENDER CATEGORY MALE FEMALE MIXED
PLEASE CIRCLE YOUR RACING CATEGORY:
OPEN TOURING GUIDEBOAT SOLO RECREATION
C- 2 RECREATION C-2 FAMILY VOYAGEUR
TOURING KAYAK UNLIMITED KAYAK 2 PERSON KAYAK
C-1 STOCK C-2 STOCK C-1 AMATEUR C-2 AMATEUR
C-4 STOCK AMATEUR C-4 PRO STOCK C-4 UNLIMITED
Participant Release
I agree that there is an inherent danger in the sport of canoe and kayak racing. By my signature below I am stating that I am in appropriate physical condition to participate and accept all risks and consequences of my actions. I agree to hold harmless the organizers, sponsors, land owners, municipalities and any other person or entity involved in the event liable for any injury incurred by me and/or my minor child while participating in this activity. I further give my permission for my name and photograph to be used for educational and promotional purposes related to paddle sports and the Adirondack Watershed Alliance. Furthermore, I release any and all royalties thereto.
Paddler 1 Signature __________________________Paddler 2 Signature_________________________
Parent Signature _______________________________Parent Signature__________________________
(Required if entrant is under 18 years old)
Paddler 3 Signature __________________________Paddler 4 Signature_________________________
Parent Signature _______________________________Parent Signature__________________________
(Required if entrant is under 18 years old)
PO Box 111 Paul Smiths, NY 12970 (518) – 891 – 2744
Hamilton County Invitational C-4 Challenge
Location: Indian Lake
Distance:10 miles
Registration Time:8:00 - 9:30
Start Time:10:00
Entry Fee: $30 pp for Amateur paddlers, $25 for AWA members, $50 pp for C-4 Pro Stock
Paddler 1: Paddler 2:
Name: __________________________________Name: ________________________________
Address: ________________________________Address: _________________________________
______________________________________ _________________________________
Home phone: ___________________Age: ____ Home phone: _______________ Age: _____
Email Address :____________________________Email Address: __________________________
Paddler 3: Paddler 4:
Name: __________________________________Name: ________________________________
Address: ________________________________Address: _________________________________
______________________________________ _________________________________
Home phone: ___________________Age: ____ Home phone: _______________ Age: _____
Email Address :____________________________Email Address: __________________________
ARE YOU A MEMBER OF AWA? YES NO ~~ ARE YOU A MEMBER OF NYMCRA? YES NO
PLEASE CIRCLE YOUR AGE CATEGORY UNDER 50 50 PLUS
PLEASE CIRCLE YOUR GENDER CATEGORY MALE FEMALE MIXED
PLEASE CIRCLE YOUR RACING CATEGORY:
OPEN TOURING GUIDEBOAT SOLO RECREATION
C- 2 RECREATION C-2 FAMILY VOYAGEUR
TOURING KAYAK UNLIMITED KAYAK 2 PERSON KAYAK
C-1 STOCK C-2 STOCK C-1 AMATEUR C-2 AMATEUR
C-4 STOCK AMATEUR C-4 PRO STOCK C-4 UNLIMITED
Participant Release
I agree that there is an inherent danger in the sport of canoe and kayak racing. By my signature below I am stating that I am in appropriate physical condition to participate and accept all risks and consequences of my actions. I agree to hold harmless the organizers, sponsors, land owners, municipalities and any other person or entity involved in the event liable for any injury incurred by me and/or my minor child while participating in this activity. I further give my permission for my name and photograph to be used for educational and promotional purposes related to paddle sports and the Adirondack Watershed Alliance. Furthermore, I release any and all royalties thereto.
Paddler 1 Signature __________________________Paddler 2 Signature_________________________
Parent Signature _______________________________Parent Signature__________________________
(Required if entrant is under 18 years old)
Paddler 3 Signature __________________________Paddler 4 Signature_________________________
Parent Signature _______________________________Parent Signature__________________________
(Required if entrant is under 18 years old)
