* Participant Name:  
 * Address:  
 * City:  
 * State:  
 * Zip:  
 * Phone:                                        
 * Age on September 20, 2014:  
 Business Phone:  
 * Email Address:  
I am a(n):                                       
Minors attending (include age:)  

The release waiver can be viewed here

I have read, understand and agree to the terms outlined in the responsibility waiver including photo/media release consent.