RACE TO NOWHERE ENTRY FORM
 

Please print clearly one entry per form • Photocopies acceptable

Release and waiver must be filled out and signed day of event. Parent or legal guardian must complete if entrant is under 18.

Make checks payable to: Mid America MS Achievment Center or MSAC

Mail To:
Mid America MS Achievement Center
3011 Baltimore
Kansas City, MO 64108
or FAX to: 816-751-7869
or Call: 816-751-7777
MAIL IN DEADLINE: (postmarked by) Feb. 21, 2009

Walk-in Registration (Day of Event Only)
The Athletic Club of Overland Park
10440 Marty
Overland Park, KS 66212
Saturday Feb. 28, 2009

On-Line Registration
Fill out form and press "Submit Form"
On-Line Deadline: February 27, 2009

Race Day Registration & Packet Pick-up:
The Athletic Club of Overland Park
Saturday, Feb. 28, 2009

Race Results:
Overall times will be posted by Sunday, March 1, 20098 on our site

By submittng the form on-line you can reserve a time slot, a T-shirt and retain a Pre-Race Day Entry Fee Amount.

To participate you must pay Entry Fee on Race Day

Prizes awarded to:
*Top Male Advanced - Top Female Advanced
*Top Team Advanced
*Top Male Novice - Top Female Novice
*Top Team Novice
*Top Fundraiser

ALL riders are eligible for both individual & team prizes. However, to be eligible for both, riders must pay two entry fees PRIOR to race time. Riders only have to race once.

NOTICE: NO CLIP-IN SHOES ALLOWED ON NOVICE LEVEL
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Individual Entrant or Team Captain Team Entry Form Below
First Name
Last Name
Address
City
State Zip
Phone
E-Mail Address
Check One M F
Date of Birth: Month/Day/Year / /
Age on Race Day
Rider Levels (check one) Advanced Novice

Complimentary Race Day T-Shirt Top of Page
T-shirt SizeM L XL XXL Must add $2 for XXL
(No Size Exchanges Day of Event)

Event Fees
$ $30.00 - Regular Entry Fee, through Feb. 27 (Postmarked Feb.21, if mailed)
$ $35.00 - Race Day Entry Fee, Feb. 28 (At The Athletic Club of Overland Park)
$ $ 2.00 - XX-Large T-shirt Fee
$ $ Contribution to MS Achievement Center
$ $ $ GRAND TOTAL
Make checks payable to: Mid America MS Achievement Center or MSAC

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Team Member Names - (Team Captain use form above)
Team Name
2.
T-shirt Size M L XL XXL
3.
T-shirt Size M L XL XXL
4.
T-shirt Size M L XL XXL
5.
T-shirt Size M L XL XXL

Desired Race Time: (check two)
Morning Mid Day Afternoon

Team Levels
Advanced Team Novice Team

Event Fees
$ $150.00 - Regular Entry Fee, through Feb. 27 (Postmarked Feb.21, if mailed)
$ $175.00 - Race Day Entry Fee, Feb. 28 (The Athletic Club of Overland Park)
$ $ 2.00 - XX-Large T-shirt Fee
$ $ Contribution to MS Achievement Center
$ $ $ GRAND TOTAL
Make checks payable to: Mid America MS Achievement Center

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