The Wheelblazer Grand Prix

2016

12/04/19

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Sign up 

Complete ALL questions on the form below:

The $30.00 Sign-up fee is waived for the 2011 Grand Prix;
 

 

How did you hear about the Grand Prix

TSWAA WEB Site  Your Team   Brochure   a Friend   Other   2015 Racer

Provide the following information:

 Sex       :      Male   Female 
 Disability      Junior  Junior E   Adult   Master   Grand Master   Quad
 
Were you a 2015 Grand Prix Racer? Yes   No       IF YES,
                                 INPUT YOUR  NAME and
                                 E-MAIL ADDRESS
                                  and COMPLETE THE LINES BELOW WHICH HAVE CHANGED.

       
 
e-mail
   
Name       
Address   
Add 2 
City  
St/Zip     
   
Birthday
 
   
Team
   
Tel
Cell
Check if you are a Member of Adaptive Sports USA

Any comments, provide below:


 
WAIVER: By clicking on the "apply for being part of Grand Prix" button
below you  hereby for yourself, heirs, executors and administrators,
waive any claim that you may have against the Henry H. Kessler
Foundation, TSWAA, Children’s Specialized Hospital and any and all
sponsors or their representatives, successors or assignees for any
injuries that may be suffered by you in this event. You certify that
you are trained and in good physical condition for this event.

You will receive an e-mail confirming your sign-up. 

 

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This site was last updated 04/27/16