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Trek for Life Entrant Form

Please fill out and submit the form below to register as a participant in Trek for Life — the Mental Health Awareness and Suicide Preventinon Memorial Hike Fundraiser over West Maroon Pass on Saturday, September 14, 2024

(*) indicates required fields.

 

ENTRANT INFORMATION
 

First Name(*)

Please enter your first name.

Last Name(*)

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City

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State

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Zip Code

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Email(*)

Please enter a valid email address.

Phone

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ENTRANT TYPE

Pre-register by selecting one option from the list below.

Individual — $45.00 (thru May 31, 2024)
1 Rider Number and 1 T-shirt.

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Select your t-shirt size1 Small - 45.00 USD1 Medium - 45.00 USD1 Large - 45.00 USD1 X-Large - 30.00 USD1 XX-Large - 45.00 USD Invalid Input

Event Entry Fees after May 31, 2024:

• $60 (June 1–21, 2024)
• $75 (At the event)

 

PURCHASE ADDITIONAL ITEMS

Pre-purchase additional items to guarantee availability.

Pedal Your Butte-Off! T-shirt - $20.00 each pre-ordered ($25.00 at the event)

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Please select a quantity:1 - 20.00 USD2 - 40.00 USD3 - 60.00 USD4 - 80.00 USD5 - 100.00 USD Invalid Input

Please select a quantity:1 - 20.00 USD2 - 40.00 USD3 - 60.00 USD4 - 80.00 USD5 - 100.00 USD Invalid Input

Please select a quantity:1 - 20.00 USD2 - 40.00 USD3 - 60.00 USD4 - 80.00 USD5 - 100.00 USD Invalid Input

Select your t-shirt sizeSmall t-shirtMedium t-shirtLarge t-shirtX-Large t-shirtXX-Large t-shirt Please select a size from the drop down list.

Select your t-shirt sizeSmall t-shirtMedium t-shirtLarge t-shirtX-Large t-shirtXX-Large t-shirt Please select a size from the drop down list.

Select your t-shirt sizeSmall t-shirtMedium t-shirtLarge t-shirtX-Large t-shirtXX-Large t-shirt Please select a size from the drop down list.

 

Waiver of Liability

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

I acknowledge that this athletic event is a test of a person’s physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities at said events. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Pedal Your Butte-Off!, Gunnison Valley Health Foundation, their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by the negligence of releases or otherwise. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during this event. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film, likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and assigns. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document; and, I understand it’s content. Invalid Input

Please enter an entrant's name.

Please enter an entrant's name.

Please enter an entrant's name.

Please enter an entrant's name.

Waiver and Release of Liability(*)

Waiver and Release of Liability

I have read and agree to the release of liability.

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ORDER TOTAL
 

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