Neptunalia Winter Challenge 2019

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Team name   First name   Last name   Email address   Gender -- Male Female   Distance Choose one 1 Mile Open One Design 3 mile Manatee Madness – 5 Mile SIT 5 Mile Dragon – 10 Mile SIT 10 Mile   Category Choose one Female Male Choose one Female 14ft-under Male 14ft- Under Prone Female Prone Male Choose one 60+ Female Race 60+ Race Male Prone Female Prone Male SUP 12'6 Female 18-49 SUP 12'6 Female 50+ SUP 12'6 Female Under 17 SUP 12'6 Male 18-49 SUP 12'6 Male 50+ SUP 12'6 Male Under 17 SUP 14 Female SUP 14 Male 18-49 SUP 14 Male 50+ SUP 14 Male Under 17 SUP SURF Female 18-49 SUP SURF Female 50+ SUP SURF Female Under 17 SUP SURF Male 18-49 SUP SURF Male 50+ SUP SURF Male Under 17 Choose one ANY Choose one 20inch over Female 20inch over Male OC1 Female OC1 Male OC2 OC6 Under 20 Surf SKI Female Under 20 Surf SKI Male Choose one 20inch over Female 20inch over Male OC1 OC1 Female OC2 Under 20 Surf SKI Female Under 20 Surf SKI Male   Event entry fee increases after December 31, 2018 Event entry fee TBD

T-shirt size None Small Medium Large Extra large Want to purchase a T-shirt NoYes 10.00 USD T-shirt size Choose one Small Medium Large Extra large SUP rental for 1 mile NoYes 5.00 USD

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver PARTICIPANT LIABILITY AND PUBLICITY RELEASE PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING. THIS DOCUMENT HAS LEGAL CONSEQUENCES AND WILL AFFECT YOUR LEGAL RIGHTS. 1. I understand that stand up paddling has an inherent risk of injury and I am participating in this event entirely at my own risk. I assert that (a) I am in good health and in proper physical condition to safely participate in the event, and (b) I have no known or knowable physical or mental conditions that would affect my ability to safely participate, or that would result in my participation creating a risk of danger to myself or to others. 2. I acknowledge and agree that none of the Event Organizer, BIC Sport North America Inc. (“BIC Sport”), their respective parent companies, subsidiaries, or affiliates, nor their respective, officers, employees, agents or representatives (collectively, the “Released Parties”) will be responsible for any injury or death sustained by me or any other participant as a result of my participation in this event. In consideration of being permitted to participate in the event, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, to the fullest extent permitted by law, I hereby forever waive, release, covenant not to sue, and discharge the Released Parties from, and agree to indemnify and hold the Released Parties harmless from and against, any and all claims resulting from or arising out of my participation in the event, including without limitation, claims of personal injury, including death, and claims resulting from damage to, or loss or theft of, property. 3. I understand that any and all photographs, motion pictures, recordings, and/or likenesses of me captured during the event by or on behalf of the Event Organizer, BIC Sport, or their respective affiliated entities or contractors, become the sole property of the Event Organizer or BIC Sport, as applicable. I hereby grant the right, permission and authority to Event Organizer and BIC Sport to use, publish, broadcast or otherwise disseminate, in any and all media worldwide, my name and any such photographs, motion pictures, recordings, and/or likenesses for any legitimate purpose, including but not limited to promoting, advertising, and marketing activities. I further understand that Event Organizer and BIC Sport have the full right to sell and/or profit from the commercial use of such photographs, motion pictures, recordings, and/or likenesses. 4. The terms of this Release shall be binding on me and my heirs, executors, administrators and any other legal or personal representatives. If I am a parent or legal guardian signing this form on behalf of a minor, I acknowledge and agree that all representations, consents, agreements and releases herein shall be regarded as made by me on behalf of the minor and shall be binding on me and the minor. I hereby certify that I have read and understand the foregoing and intend to be legally bound. I accept the terms of the waiver Name of parent or guardian who approves this activity