JIM’S 2nd ANNUAL

GOURMET CHALLENGE

A BENEFIT FOR:

THE LANCE ARMSTRONG FOUNDATION

SATURDAY, SEPTEMBER 6, 2008

PLEASE PRINT LEGIBLY

                    

                 FIRST NAME____________________ LAST NAME____________________________

                    

                     MAILING ADDRESS______________________________________________________

                    

                     CITY__________________________STATE__________________ZIP _____________

                    

                     TELEPHONE_______________________EMAIL______________________________

 

                     I PLAN TO RUN/RIDE THE INDICATED ROUTE: (PLEASE CHECK ONE!)

                        __ ½ METRIC CENTURY (HILLY AND MODERATELY CHALLENGING)

                        __ FULL METRIC CENTURY (CHALLENGING)

                        __ 5K WALK/RUN

                        __ 10K WALK/RUN

                        __ ADDITIONAL FOUR COURSE LUNCHES @ $50 EACH

 

**THE ENTRY FEE FOR ALL RIDERS IS $50.00. IN ADDITION, EACH RIDER MUST RAISE A MINIMUM OF 100 EXTRA DOLLARS IN DONATIONS WHICH CAN BE PAID AT REGISTRATION ON THE DAY OF THE RIDE (CASH OR CHECKS PAYABLE TO THE LAF ONLY)!!

**THOSE REGISTERING FOR THE WALK/RUN NEED ONLY TO RAISE AN ADDITIONAL $50 TO BE PAID THE DAY OF THE EVENT. CHILDREN UNDER 16 MAY WALK/RUN OR RIDE FOR JUST $50 WITH NO ADDITIONAL FUNDRAISING IF ACCOMPANIED BY AN ADULT OVER 18

HELP TO SPREAD THE WORD OF THE LANCE ARMSTRONG FOUNDATION

PRIZES AWARDED TO THE TOP FUNDRAISER IN EACH CATEGORY

METHOD OF PAYMENT:

___ CHECK (MADE PAYABLE TO THE LANCE ARMSTRONG FOUNDATION)

___VISA___MASTERCARD  CARD NUMBER___________________________EXP DATE________

3 DIGIT CODE ON BACK______SIGNATURE______________________________ 

PARENTS SIGNATURE IF RIDER IS UNDER 18 YEARS OF AGE____________________

 

BY SIGNING ABOVE, I UNDERSTAND THAT MY REGISTRATION FEE IS NON-REFUNDABLE. IN SIGNING THIS RELEASE, I HEREBY ACKNOWLEDGE THAT I UNDERSTAND THE INTENT THEREOF AND I HEREBY AGREE AND WILL ABSOLVE AND HOLD HARMLESS THE ORGANIZERS OF THIS EVENT AND THE LANCE ARMSTRONG FOUNDATION ALONG WITH ANY OTHER PARTIES CONNECTED TO THIS EVENT IN ANY WAY  AND WILL IN NO WAY SEEK DAMAGES FOR ANY LOSS, DAMAGE , INJURY OR DEATH AS A RESULT OF MY PARTICIPATION IN THIS EVENT. I FURTHER AGREE THAT I AM RESPONSIBLE FOR THE ADDITIONAL$50 OR  $100 ADDITIONALDONATIION WHETHER I AM ABLE TO PARTICIPATE OR NOT.

 

SEND YOUR COMPLETED APPLICATION AND PAYMENT TO

GOURMET CHALLENGE

P.O. BOX 1930, SANTA YNEZ, CALIFORNIA   93460

IF PAYING BY CHARGE CARD YOU MAY FAX BACK TO: 805-693-1659

A CONFIRMATION EMAIL WILL BE SENT TO YOU!!

STAY TUNED TO WWW.THEVINEYARDHOUSE.COM FOR MORE INFO!!

REGISTER NOW!!! EVENT IS LIMITED TO THE FIRST 100 PAID ENTRIES!!