Registration

PMI Total Fitness
124 South 2nd St.
Waterville, MN
56096

Address___________________________________

  E-Mail ______________________

Phone(      )_____________________

Age:                           

Under 13 [  ]                    
13-20       [  ]                      
21-35       [  ]                   
36-50       [  ]               
51-65       [  ]
66+          [  ]             

Gender   M  [  ]   F  [  ]

Race participating in:

[  ] 11 mile paved bike
[  ] 10K run
[  ] 5K cross country run
[  ] 5K cross country walk
[  ] 5K run & 10 mile bike combination

Where did you hear about this race?______________________

I do waive, release & forever discharge the sponsors & it's officers, employees
representatives & all others from any responsibilities or liability for injuries
of damages resulting from my participation in any of these events.

Signature:_______________________ Date:_______________________