Name:  
      Address:  

         City:  
        State:     Zip: 
Business Phone:  Date of Birth:  Age on race date: 
Home Phone:     
Email Address:  	   
	   Race Distance:  50 Mile 50K 30K10K Run/Walk
	   Race Entry(Postmarked by 1/26/11): $60$40(30K)$25(10K)
	   Late Entry(1/27-2/19/11 Postmarked): $65 $45(30K)$30(10K)
	   Race Day Entry: $75 $55(30K)$35(10K)
	   Extra Meal Ticket: $7
	   Gender: M F
           T-shirt Size:  S M LG XL
	    

Waiver Must Be Read and Signed Before Mailing:
In consideration of my entry, I myself,heirs,executors, administrators, and assigns waive and release any and all rights and claims against the Pony Express 50 Mile Run/50K Run/30K/10K, also any related coordinators, sponsors, volunteers, supporters, Ultrarunner.net LLC, Lake of the Sky Trail Runners Running Club, and employees of Cameron Park Lake, California. I further attest that I am physically fit and have trained for this said event.I also agree to any/all medical treatment to be administered to me during or after completion of this event. I also waive any negative or positive input to the above race director during this event and will withdraw at the request of the above. I also accept full responsibility for my actions, etc. All fees are nonrefundable. Shirt/sizes not guaranteed for late or race day entries. A $25 Service Fee for all returned checks.

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Signature                            Date