REGISTRATION FORM - Maple Syrup Stampede - February 10, 2007

Name:__________________________________________________Male:_____________Female_________

Address:_________________________________________________________________________________

___________________________________________________________Phone No. _____________________

Age of those 13 years and under as of Dec 31, 2006:  _____________________

Skating _____________ Classic________________________

I enclose $_________for entry in the Maple Syrup Stampede. Money Orders & Cheques should be made payable to "Jocelyn Recreation Committee" and send to: R.R #1, Hilton Beach, ON POR IGO

Entry Fees:    $15 before Jan 10         $20 from Jan 11 to Feb 6          $30 from Feb 7 to 10

No refunds except in the case of the event being cancelled & then a $2 entry fee will be retained for administration costs.

Release and Waiver

I the undersigned know that skiing is an action sport and carries significant risks of personal injury. I know that there are natural and manmade obstacles and hazards, surface and environmental conditions and risks which in combination with my actions can cause me very severe and occasionally fatal injury. I agree that I am totally responsible for my safety while I participate in this event and will not hold the Township of Jocelyn, Jocelyn Recreation Committee or property owners responsible for any injuries sustained in this event.

SIGNATURE:________________________________________________ DATE:____________________________

Parental signature required for entrants under 18 years of age.