The Incredible Road Rally March 24th, 2018 4:00pm Departure Registration: $15 per car Prizes: $100, $50, $25 All proceeds donated to the NCKDSS Hosted by the Family of Isaac Thoman. For more information contact Shella at 785-275-1777

Registration

• Team Name
• Contact Name First Last
• Email Address
• Mailing Address
  Street Address
  City State Zip
• Phone Number (###) ### ####
• Payment Preference Pay online. Pay at Event. Mail payment to: NCKDSS, C/O Shella Thoman, 703 E 7th, Concordia, KS 66901
• Waiver. In consideration of me and/or my minor child(ren) being permitted to participate in this event, I hereby for myself, my heirs and personal representatives assume any and all risks which might be associated with the event. I further waive, release, discharge and covenant not to sue the Down Syndrome Society, its officers, employees, sponsors, organizers, volunteers or other representatives or their successors and assigns, for any and all injuries or damages of any kind whatsoever suffered by myself and/or my minor child(ren) as a result of taking part in the event and any related activities. I also authorize the use by NCKDSS of any photo, film or video tape taken of me or my minor child(ren) at the event for any purpose. I agree to the waiver.
• Please list any comments or notes. Thank you.