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THE MEADOWS MONSTER DUAL SERIES

4th

- DUAL IN THE DARK XC 2/10/2This is the first race of two, for the 2013 season

WHAT: 2 mile Run 10 mile Bike 2 mile Run------------------------------------------------------------------------------------------------------------------------------------------------------

WHEN: April 27, 2013-------------------------------------------------------------------------------------------------------------------------------------------------------

TIME: 5:45 PM Check In (at start line)6:45 PM Start (1 hr. before sunset)------------------------------------------------------------------------------------------------------------------------------------------------------

WHERE: Lowell Park, Dixon IllinoisBoat Ramp Concession Stand

-------------------------------------------------------------------------------------------------------------------------------------------------------COURSE: Run course at Lowell Park

Bike course at Park and Meadows-------------------------------------------------------------------------------------------------------------------------------------------------------

Race Day $10 Single/ $20 Team of (2) / $30 Team of (3)Registration Only:

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Required Bring your own Headlight/s or Flashlight/s,Equipment: (Mountain) Bicycle, and Helmet.

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Come test your XC Dual Sport ability, have some fun, and see how long it takes to

Hunt the Meadows MonsterRun Course Terrain: 10% Pavement, 90% Dirt and Grass.

Bike Course Terrain: 70% Pavement, 20% Gravel, 10% Dirt and Grass.Water, Gatorade & Snacks available at the finish line. Awards for top 3 male, female and team.

Check us out on-line at www.meadowsmonster.com----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

RACE DAY REGISTRATION ONLY - BRING THIS REGISTRATION FORM WITH YOU ON THE DAY OF EVENT-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------SHIRTS WILL BE SOLD AT THE EVENT COMMEMORATING THE CAPTURE OF THE MONSTER. DETAILS ON WEBSITE. IF YOU WOULD LIKE

TO HAVE MORE INFORMATION ON THE MEADOWS MONSTER OR ANY QUESTIONS E-MAIL (meadowsmonster@gmail.com)

Donations made by:

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Entry Form / Release FormMeadows Monster - XC Duathlon

April 27, 2013 6:45 PMLowell Park Dixon, Illinois

Name: _________________________________________________ Age: __________ Gender: Male / Female

Address: ________________________________________________ City: ________________ Zip: _________

E-mail: _______________________________________________________________ (FOR RACE RESULTS)

Emergency Contact: ___________________________________________Phone: ________________________

Team Entry (Relay only):Team Name: ______________________________________________________________________________

Runner: __________________________________________________________________________________

Cyclist: ___________________________________________________________________________________

Runner: (Optional) ________________________________________________________________________

Waiver and Release of Liability Agreement

NOTE: Each Relay Team member will be required to sign a waiver on the day of the event.

I, the undersigned, hereby acknowledge and understand that the athletic event commonly known as the Meadows Monster Challenge XC Duathlon held onSaturday, April 27, 2013, at Lowell and Meadows Park located in Lee County, Illinois (the Event), is an extreme test of individual physical and mental limitsand carries with it certain risks including, but not limited to, death, serious injury and property loss, caused by such things as nutrition, hydration, terrain,facilities, weather conditions, equipment, vehicular traffic, actions of other people such as participants, volunteers, spectators, coaches, officials, and/ororganizers of this Event. I acknowledge that these risks are inherent in athletic events of this type. I hereby assume all of the risks of participating and/orvolunteering in this Event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released hereby and/or

from dangerous or defective equipment or property owned, maintained or controlled by them. I certify that I am physically fit and prepared to participate in thisEvent and have not been advised otherwise by qualified medical personnel. I acknowledge that this Accident Waiver and Release of Liability form will be usedby the event holders, sponsors and organizers of the Event and that it will govern my actions and responsibilities at the Event. In consideration of myapplication and allowing me to participate in the event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, andassigns as follows:

I expressly and voluntarily Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, and/or propertytheft, the following entities or persons: the Dixon Park District, City of Dixon, County of Lee, the Event organizers, directors, sponsors, volunteers, and any andall officers, employees, volunteers and agents of the foregoing entities/organizations (collectively, the Released Parties). Further, I expressly and voluntarilyIndemnify and Hold Harmless the Released Parties from any and all liabilities or claims made as a result of participation in the event, whether resulting fromones negligence or otherwise.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the Event. I understandthat during the Event or related activities, I may be videotaped and/or photographed. I agree to allow my photo, video, film and/or other electronic likeness tobe used for any legi timate purpose by the Event holders, producers, sponsors, organizers and their assigns.

This Accident Waiver and Release of Liabili ty shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicablelaw. I hereby certify that I have read this document, and I understand its content.

Signature: ___________________________________________________________________

Date: ______________________

Signature of Guardian (if participant is under 18): ____________________________________________________

Date: ______________________