Participant Name *

First Name

Last Name

Phone

(###)

###

####

Distance *

BURGR95

Fork Horners 47

Liability waiver *

I am over 18 and understand the above liability waiver agreement terms and conditions.

Legal Guardian Name (if participant under 18)

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Would you like to share your personal story?

During this unprecedented time we want to inspire others - help us! By checking this box we'll reach out to find out more about your story and why you're doing this event. Your story may be shared on our social media platforms.

Yes

No

*

I will wear a helmet and abide by the rules of the road.

*

I grant permission to IRONBULL, INC. to use my photographs and videos which I may share, or any other record of this event for any legitimate purpose.