Please fill in the requested information below press the preview button, verify information
on the next screen then press the "Pay Here" button where you will be taken to the Paypal
processing site where you MUST select payment method and provide any information they
require. Once successfully paid you will be redirected to the LSU Confirmation page.
NOTE: If Payment is Successful you will receive payment confirmation email (within 24hrs) both
from Paypal and entry confirmation from us (if you do not receive our email within 24hrs
OR are having trouble with this entry form please contact us at ranmorz@telusplanet.net.)
IF you DO NOT RECEIVE CONFIRMATION YOU ARE NOT ENTERED!!. |
Visa, M/C, Paypal ** ALL Payments are handled securely by Paypal ** DATA GRAPHX
and will appear on your Credit Card OR /Paypal statement as such.
YOU CANNOT TRANSFER YOUR ENTRY TO ANOTHER RUNNER...NO MATTER WHAT REASON!!
HALF of the entry fee is refundable before MIDNIGHT JULY 12/2012
AFTER THAT YOUR ENTRY FEE WILL BE 100% NON-REFUNDABLE |
| Fees: |
BEFORE AUG. 20th 2012:
100 Miler - $176.75
(includes $6.75 processing fee)
100 KM - $150.75 (includes $5.75 processing fee)
50 KM - $130.00 (includes $5.00 processing fee) LOTTERY ONLY SORRY FULL!
ON OR AFTER AUG. 20th 2012:
100 Miler - $197.00
(includes $7.00 processing fee)
100 KM - $171.00 (includes $6.00 processing fee)
50 KM - $150.00 (includes $5.00 processing fee) LOTTERY ONLY SORRY FULL!
Extra Adult Meal Tickets: $15.50/ea (includes $.50 processing fee)
Extra Child Meal Tickets: $10.50/ea (includes $.50 processing fee)
LSU Hats & Toques: $20.75/ea (includes $.75 processing fee) |
| REQUIRED FIELDS = *
|
|
| SORRY 50KM & 100KM are FULL |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
xxx-xxx-xxxx |
|
xxx-xxx-xxxx |
|
(E-mail)
|
|
|
|
mm/dd/yyyy |
|
|
|
|
SORRY 50KM & 100KM are FULL |
|
|
|
|
|
|
|
|
|
|
|
|
|
$
|
|
$
|
|
$
|
|
$
|
|
$
|
|
$
click in field to update Total |
| Medical/Emergency Info: |
|
xxx-xxx-xxxx |
|
|
|
|
|
|
| A Travel question for out of towners .. |
|
|
| WAIVER: |
Please read and sign by clicking the waiver agreement below -
I know that trail racing is a potentially hazardous activity. I should not enter and run unless I am medically
able and properly trained. I agree to abide by a decision of the race officials relative to my ability to safely
complete the run. I assume all risks associated with running in this event including, but not limited to: falls,
contact with other participants, the effects of weather, including cold, heat or high humidity, and all such
risks associated with trail running. Having read this waiver and knowing these facts and in consideration
of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive, and release
Runners Soul Inc., and all race officials and agents, all sponsors, their representatives and successors
from all claims or liabilities of any kind arising out of my participation in this event even though that liability
may arise out of negligence or carelessness on the part of the persons named in this waiver. |
|
|