Rockin' Fall Classic
 at the San Diego Velodrome
 SATURDAY, OCTOBER 20, 2001
 (Rain date: Sunday, October 21, 2001)

Please fill this form out completely and mail with payment to: San Diego Street Elite, 9805 Genesee Ave., San Diego, CA 92121-1803. Make check or money order payable to San Diego Street Elite. Do not send cash.

NAME

ADDRESS

CITY, STATE

PHONE

CLUB/TEAM AFFILIATION (IF ANY)

E-MAIL ADDRESS
CATEGORY / REGISTRATION FEE:
  PRO/ELITE - $30
  WOMEN - $30
  ADVANCED - $30
  BEGINNER/INTERMEDIATE - $20
NOTE: Women may enter "Women" and/or another category.
Deduct $5 if pre-registering before 10/13/01. 		BIRTHDATE (MM-DD-YY)

SEX:
  M           F

T-SHIRT SIZE:
  M           L           XL
Sorry, but T-shirt sizes are not guaranteed.

WHAT TYPE OF EVENT DO YOU NORMALLY RACE?
(Check any and/or all that apply.)
  INDOOR               ROAD
  OUTDOOR           TRACK
  NONE - FIRST TIME 		FOR OFFICIAL USE ONLY:

PAYMENT RECEIVED

BIB NUMBER

LIABILITY/MEDICAL RELEASE
        In consideration of being allowed to skate or any type of athletic activity on the San Diego Velodrome, I hereby release, hold harmless, and forever discharge the San Diego Velodrome Associatoin (SDVA), San Diego Street Elite (SDSE), the City of San Diego and any subsidiaries or affiliates, and every officer, board of directors, agent, and employee from all claims, causes of action or demands of any kind which I may have in the future or that any person claiming through me may have in the future against the above named entities for any reason of injury to person or property, or death, in connection with my participation in the above described activity.
        I fully understand and acknowledge that skating or participating in athletic training involves strenuous physical activity and somtimes body contact and that there are adherent risks and hereby warrant and affirm that I am in good physical condition, that I am physically able to fully participate in the activities described above. I give consent to an authorized administration of all treatments considered advisable and necessary in the judgement of a licensed physician or medically trained personnel.
        I have read this release, and understand the terms used in it and the legal significance. This release is freely and voluntarily given with the understanding that rights to legal recourse against the SDVA, SDSE, the City of San Diego and any of its subsidiaries or affiliates, and every officer, board of directors, agent and employee are knowingly given up in return for allowing my participation in the activity above.

Signature _______________________________________________________________________________   Date ___________________________________

For participants under the age of 18:
        This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree not only to his/her release and indemnify the SDVA, SDSE, the City of San Diego and any of its subsidiaries or affiliates, and every officer, board of directors, agent and employee from any and all liabilities incident to my minor child's involvement or participation in these programs for myself, my heirs, assigns and the next of kin. I hereby give consent to and authorize the administration of all treatments considered advisable and necessary in the judgement of a licensed physician or medically trained personnel.

Parent/Guardian Signature ___________________________________________________________________   Date ___________________________________

Relationship _________________________________________________________


INLINE RACING CLUB