Registration

2006 Entry form Canadian Death Run and Kids Death Run
Please enter with a current year entry form.

*One entry form per person.

Save $10 per person for adults and $5 per person for the kids Race if you register online! (But remember to sign the waiver and mail it into us if you are registering a team..)
We accept photocopies of this entry form
Please Print clearly

________________________________________________________
Name (print clearly)
Age on race Day: _________________
Today's date: _________________

Date of Birth:(dd/mm/yy)___________________________________
Age on race day(min 16 for death race, 15 and under for Kids Death Race)_________
(Age on race day will determine categories for prizes.)

Male       Female

________________________________________________________
Mailing address (Street address/Post Office Box)

________________________________________________________
City, Province/State, Country

_______________________
Postal Code/Zip

_________________________________________________________
E-mail address (print very clearly)

___________________________
Phone number

Contact Person in case of Emergency:

Name: ____________________________________________________

Phone: _____________________

Medical:
Do you have any Health Problems that may affect you adversely during the Race?
   Yes   No
Describe if Yes:_____________________________________________
_________________________________________________________
_________________________________________________________

You must enter with total commitment.
No refunds or transfers once entry is accepted. Your cancelled cheque/credit card receipt is your confirmation. We will mail you our Canadian Death Race Program approx. 1 month prior to the event. For the Kids Death Race please pick up your race kit at the Friday night race registration, there is no information mail out for the Kids Death Race. Entry for Adult race includes cool race kit goodies, T-shirt, recreation centre pass, 2 meals (pre-race pasta extravaganza, Saturday meal, food on course for racers while competing, and (if you are tough enough to finish under the slated race cut off time) a custom made Canadian Death Race coin with engraved display case. For those not having a team but wishing to do the relay, check the "join team" box on the form below, remit your portion of the relay fee, entry form, signed waiver and we will accommodate you - guaranteed.   No post dated cheques accepted. All "join a team" racers must show up at the race registration on Friday so we may put you on a team.

All Fees are payable in Canadian Dollars.
Must be 16 years or older as of race day for Death Race. Must be 15 or under as of race day for Kids Race. Entry Fees include GST

Registration Fees	Early Bird (before March 1st)	Late (before June 1st))
Solo	$250 + GST	$295 + GST
Relay Team Member	$250 + GST	$295 + GST
Kid	$25 + GST	$45 + GST

**GST is for Canadian Entries only.

No entries accepted after late registration deadline of June 1st, 2006.

Canadian Death Run:       Solo          Relay         Kids

Please put me on a relay team for the Run
I have included my portion of the relay fee.

_______________________________________________
Relay team name (tasteful please)

Racers names in order of relay leg
Relay order must be submitted with this application regardless of
The number of team members. Each relay person must identify which legs they are doing. Blanks left to be filled in at a later date will result in a $25 administration fee. We now accept relay teams of 2,3, 4 and 5 members.

Number of runners on team:_______________________________
**Team Captain:_________________________________________
(Team Captain will be the contact individual for the team.)
Please list all team members:
Leg 1)_______________________________________________
Leg 2)_______________________________________________
Leg 3)_______________________________________________
Leg 4)_______________________________________________
Leg 5)_______________________________________________

Relay category:
Male
Female
Mixed (at least one female or one male)
Senior (total age of team is an average of 60 years per team member)

Note:
There is a $25 administration fee for relay teams to make changes to your application specifically for (but not limited to) changing the relay order or making a relay racer substitution due to illness or injury, filling in relay team member blanks at a date later then the submission of the entry. There are no changes permitted after the late registration deadline of June 1st, 2006. Read the course descriptions carefully and match your racer's ability to the course profile. Our web page has complete details and maps: www.canadiandeathrace.com

Important:
Each Relay person must fill out an individual application and sign waiver. Submit all applications of team members together with the correct fee.
Solo division substitution strictly prohibited - see entering with total commitment.
Make cheques payable to: Canadian Institute of Extreme Racing.

Death Racers are a breed apart. What's your story? Tell us about your exciting, grueling, and/or amusing, racing highlights. . .
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

T-shirt size:
Adults:    Small       Med.     Large       XLarge

Kids:    Youth Small      Y-Med.       Y-Large
Note: Late entries may not receive a T-shirt.

Payment Options:

Cheque*, Money Order, Visa, or MasterCard

*Please make Cheque payable to: Canadian Institute of Extreme Racing.

Total remitted for entry fees: $_________________(see above for fees)

______________________________________________________
Name as it appears on your credit card (please print):

_________________________________________   ___________
Card #                                            Expiry date

______________________________________________________
Signature

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Death Warrant (Waiver): Read this before you sign!
The Canadian Death Race presents extreme and unknown risks for which I freely and voluntarily agree to be solely responsible. I am aware that a race of over 100kms is extremely difficult and hazardous for even well trained athletes under the most favorable conditions. I acknowledge that I am physically fit and sufficiently trained to participate in this extreme mountainous endurance event, in which altitude, and broad temperature ranges will be a factor, and I assume all risks of such participation. I have been advised that I may be exposed to physical injury from a number of natural factors, including but not limited to snow on the trail, lack or over abundance of water, animals, vehicular traffic, etc. I also acknowledge that a portion of the race will take place at night and assume the risks for participating in the darkness, which augments the dangers, described above. I acknowledge that the race takes place over remote territory and assume the risk that I may become injured or incapacitated in a location where it is difficult or impossible for event's management to get required medical aid to me in time to avoid physical injury or even death. Knowing these facts, I nevertheless in consideration of my accepting this entry, hereby for myself, my heirs, executors and administrators, waive, release and discharge the Canadian Institute of Extreme Racing, The Canadian Death Race, Town of Grande Cache, Alberta Athletics Association, any official sponsor entity, and the officers, directors, shareholders and/or members, agents, and employees of each, all medical and other personnel assisting with the race, volunteers, or any other person connected with this event, from any and all rights, claims of or in connection with my participation in this event. I further agree that I will defend, indemnify and hold harmless the Canadian Institute of Extreme Racing or any official sponsors, and the directors, officers, members and agents of each, against all claims, demands and causes of action. In addition, I agree to be responsible for the actions of my crew. This release extends to all claims of every kind and nature whatsoever, whether known or unknown. I grant my irrevocable permission to the Canadian Institute of Extreme Racing and its authorized agents, to use my name and any photographs, videotapes, motion pictures, recordings, and any other record of my participation in this event. No entry will be accepted without a signature. Race management reserves the right to refuse any entry. No entry accepted without full payment. There will be no refunds or transfers once entry is accepted. Allowable changes made to your race application (relay order, relay substitutions, changing from a 5 person team to a 4, 3, or 2 person, or changes from a 2 person team to a 3, 4, or 5 person team etc) are subject to a $25 administration fee. No changes allowed after the late registration deadline. Absolutely no refunds.

__________________________________________________________________________________
Athletes Signature                               Date

__________________________________________________________________________________
Parent or guardian’s signature if athlete is under 18 years of age.
Minimum age of participation is 16 years old as of race day for the Death Race Adventure Series; 15 years or under for Kids Death Run.

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Timing Stick Deposit
The Canadian Death Race will be utilizing a new state of the art timing technology for 2005 that includes the use of specialized computer timing sticks for each runner on course. This system will vastly improve our safety, timing, tracking and reporting abilities. Because the equipment is costly, a deposit of $50 will be required for each timing stick. (One per soloist or one per team - teams sticks will be passed to each subsequent relay racer at the appropriate leg transfer stations.) The timing stick stores the users information so that our timing experts can keep track of your progress throughout the race. If the timing stick is lost, the runner will not be able to complete the race and the user/team will be disqualified. If a racer is disqualified or surrenders prior to the finish of the race, their stick must be surrendered along with their Death Race coin.
Please send either a postdated cheque for August 1st, 2005 or, if you wish, your credit card information and authorization via fax or mail for the deposit. (See printable form below for submission information.)   Your cheque will not be cashed and your credit card will not be charged and will be held on file until Monday, August 1st, 2005. In the event that a timing device is not returned during or at the end of the race, only then, will your cheque be cashed, or the credit card be processed.

I have enclosed a post dated check for August 7th, 2006 OR

I hereby authorize the Canadian Institute of Extreme Racing to charge my

Visa

MasterCard

the amount of $50 in the event of a non-returned timing device on August 7th, 2006.

__________________________________________________________________________________
The name as it appears on the credit card. (Please Print Clearly)

__________________________________________________________________________________
Credit card number. (Please Print Clearly)

_____________________________
Expiration Date. (Please Print Clearly)

_______________________________________________
Signature

Accommodations (book early):
All hotels and motels in Grande Cache are only a short walk from the race start. We recommend reservations.
Please support our sponsors below;

Acorn Motel 780-827-2412
Best Western Grande Mountain Getaways Hotel: 780-827-3303
Big Horn Motor Inn 780-827-3744
Grande Cache Hotel 780-827-3377
Inn on the Valley 780-827-2453
Misty Mountain Inn and Suites 780-827-4268
Municipal Campgrounds: 780 827-3362
Outback International Bed and Breakfast: toll free 1 866 827-4406 or 780 827-4406
(E-mail: blujay_@hotmail.com)
Sheep Creek Back Country Adventure Lodge 780-831-1087
Indoor Camping at Rec Center 780 827-2246
Wild Blue Yonder Lodging House: 877 WILD RUN (945-3786)

Billeting Program
We anticipate that all commercial hotel space will be full for the entire week leading up to the each event. To accommodate the multitude of racers we are structuring a billeting program where you may stay in a room with a Grande Cache family. Other options are available including 5th wheel rental, and indoor/outdoor camping, fees vary. The billeting program will only be available once hotel/motel space in town is full. Hotels and motels in Grande Cache are reasonably priced, clean, and located only a short walk from the start/finish area. This should be your first option for accommodations. Check it out on-line at http://www.canadiandeathrace.com/Billeting

Mail form to:
Canadian Death Race
Box 477
Grande Cache, Alberta, Canada
T0E 0Y0
Or Fax to: (780) 827-4194

STOP! Before you send this, did you:
   Sign the waiver & fill out the timing stick deposit form?
   Book accommodations?
    Remit the proper $$ (entry fee)?
   Include your phone number and Email address?
Give us your racing highlights or brief biography or why compete in the Death Race
Sign the waiver & fill out the timing stick deposit form?
Are you sure you want to do this?
Go Death Racer!
Did we mention, sign and send the waiver and the timing stick deposit form?

Need More info?
Contact us at (remember we prefer email, it's cheaper too)

Phone:
	Grande Cache Tourism Center 780-827-3300.
	Death Race Central Emergency Hot Line: 780-827-5413
	Fax: 780-827-4194
E-mail:	info@canadiandeathrace.com
Web Page:	www.canadiandeathrace.com
Mail:	Canadian Death Race
	PO Box 477
	Grande Cache, Alberta Canada
	T0E 0Y0

Other events in the Grande Cache Area
- Grande Cache Wild River Rendezvous is held every year on the first weekend in June.
; June 3rd, 4th, 5th, 2005. This event is for whitewater enthusiasts (kayaks, canoes, C1, C2, etc), and exposes paddlers to our exciting local whitewater rivers.
- Passport to the Peaks Program (www.passporttothepeaks.ca) - get your passport guidebook and hike the breathtaking ring of mountains that surrounds the Town of Grande Cache for a bronze, silver or gold hiking pin. Register at the Grande Cache Tourism Center. Hiking Guide/Passport stamps, and maps $60.
- Canadian Death Run - Aug 5th, 6th, 2006.