Pacific Outrigger Canoe Club

The Rusty Iron Outrigger Canoe Race

Saturday, April 26, 2014 – Frenchman’s Bar, Vancouver, Washington

Race Entry Form Complete one entry form per team. Registration discount: Mail this form, waivers and $120 per OC6 before April 15 to address below. Paddlers race free after their first race. Junior paddlers, 19 and under, race free. One team contact person must check in at the registration table at the race site.

Club

Contact name

Contact address

Phone

City, state, zip

E-mail

Canoe Number _________ Color 1. Check one division: 2. Check course:

Canoe must have number applied.

Women

Mixed

Men & if

Long (between 8 and 9 miles)

3. Check one canoe type: 4. Check one class:

OC6

OC2

Open (any age)

Senior Master (50+)

Unlimited

Short (4 miles)

OC1

Other

Novice (1st & 2nd year paddlers)

Golden Master (55+)

Master (40+)

Kupuna Master (60+)

Junior age

Paddlers must be current members of USACK with USACK number entered below or pay $10 EventOnly fee. “On File” written on line for USACK membership number cannot be accepted. All paddlers must submit a signed USACK waiver. A signed PNW ORCA waiver is not necessary if PNW ORCA has a waiver with paddlers’ current info on file.

Paddlers’ first & last names

USACK number

1. 2. 3. 4. 5. 6.

Registration fee received by April 15 OC6 = $120 OC1&2 & Other= $20 each paddler Date received: ______________ Fee after April 15: OC6 = $150 OC1&2 & Other= $25 each paddler

Make check payable to Pacific Outrigger. Bring Entry Form to race or receive discount for preregistration by sending $120 per OC6 and waivers prior to April 15 to Charlene Dickinson, 13196 SW 17th St, Beaverton, OR 97008. Questions: 971-322-7794, [email protected] For Pacific Outrigger use: Check No._________________________ Waivers attached __________________

Checks$_________

Cash_______

USACK$___________

Race$_______