* 1. Full Name

* 2. What is your street address?

* 3. Phone

* 4. Email Address

* 5. TEAM NAME (if applicable)

* 6. Emergency Contact Name

* 7. Emergency Contact Address

* 8. Emergency Contact Phone

* 9. Relationship

* 10. By signing below, I understand that CCD/KMOJ RADIO does not require me to participate in this competition, but I desire to do so, therefore, I agree to assume and take on myself any and all risks and responsibilities that are in any way associated with this competition. I release CCD/KMOJ RADIO and its representatives from all liability, claims and actions that may arise from injury or harm to me or from damage to my property in connection with this activity. 

I have read and understand and agree to the terms and conditions listed above.

T