E-SIGNATURES Name* First Last Email* Date Of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Event / Race*NOCO HALF & 10KTIMBERVIEW TRAIL RUNLAST CALL TRIATHLONNARROWLEAF LAKE RUNBIB NUMBER*I accept the terms, conditions & waivers*I have read and agree to all Breakaway Athletic Events Terms, Conditions, Rules & Policies * I have read & agree to all terms & conditions stated in the Breakaway Athletic Events Waiver and Release of Liability / Assumption of Risk and Indemnity Agreement YES Sign Initials of Participant in agreement or Parent/Guardian of Participant under 18*I agree to all USAT and/or USATF terms, conditions & waivers*I have read and agree to all USAT Terms & Conditions I have read and agree to all USATF Terms & Conditions YES Initials of athlete over 18 years of age or parent/legal guardian of minor under 18 years of age or legal guardian of incapacitated and/or mentally challenged person* Δ