East Coast SportsCamp 2008 Registration Form

Home Page

Name: _______________________________

Address: _____________________________

City: _________________________________

State: _____________ Zip:_______________

Telephone: ____________________________

E-Mail: _______________________________

Enclosed is my check for $ 275  __________
Please Make Check Payable to C-MAC

Release Statement

I understand that the SportsCamp involves vigorous physical activity that could result in personal injury to others and myself. I hereby take full responsibility for my safety and release, hold harmless and indemnify Courage, CMAC (Courage Members Action Committee), their officers, sponsors and volunteers, from any and all liability, negligence and all responsibility whatsoever in the event of personal injury or death.

Signature: _________________________________

Date: ____________________________________


Please print out this form, complete it and mail it, along with payment to: