Gdca Application Form PDF Details

The Gdca Application form is an essential tool for anyone looking to participate in the diverse range of events offered during the 2017 Publix Gasparilla Distance Classic Race Weekend, scheduled for February 25-26. Participants entering the 15K, 5K, Half Marathon, and 8K races, as well as those taking on the Michelob Ultra Challenge, Michelob Ultra Amber Challenge, or Michelob Ultra Lime Cactus Challenge, are required to provide comprehensive personal information, including email, name, address, projected finish times, actual age on race day, T-shirt size, and contact numbers. This form not only facilitates registration but also includes a waiver section to be acknowledged and signed by the participant (or parent/guardian if under 18), indicating an understanding of the risks involved and consenting to potential emergency treatment. Furthermore, specific race fees are detailed for each event, including special pricing for military personnel and challenges that combine multiple races. Important to note is the strict policy on entry fees being non-refundable and non-transferable, underscoring the commitment required upon signing up. Instructions for payment, alongside options for online registration and contact information for inquiries, provide prospective participants with all they need to secure their place in these eagerly anticipated races.

QuestionAnswer
Form NameGdca Application Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesgdca exam form, gdca exam 2020 application form date, gdca exam 2021 application form date, gdca online registration 2021

Form Preview Example

2017 Publix Gasparilla Distance Classic Race Weekend 2/25-26/2017

Email _________________________________________________________________________________________________

Last Name _____________________________________________________________________________________________

First Name ____________________________________________________________________________________________

Address/Apt. #__________________________________________________________________________________________

City_________________________________________________State __________________ ZIP________________________

Country_____________ Projected Finish Time:15K _______ 5K _________ Half Marathon ___________ 8K ____________

 

 

XS

S

M

L

M

F Actual Age on Race Day _____________ Date of Birth _______________ T-shirt Size

XL

XXL

XXXL

 

 

 

Gender Speci

 

 

Work Phone _______________________________________ Home Phone________________________________________

F O R R E G I S T R A T I O N C O N F I R M A T I O N , A N E M A I L A D D R E S S M U S T B E P R O V I D E D

In consideration of my entry being accepted in the Publix Gasparilla Distance Classic 15K, 5K, Half Marathon, 8K, Michelob Ultra Challenge, Michelob Ultra Amber Challenge, or Michelob Ultra Lime Cactus Challenge, I, intending to be legally bound, do hereby, for myself, my heirs, executors, and assigns, waive, release and forever discharge any and all rights and claims for damages that I may have or which may hereafter accrue to me against the Gasparilla Distance Classic Association Inc., Publix Super Markets, the City of Tampa, Hillsborough County or any subsidiary or political subdivision thereof, its or their respective o, agents, representatives, successors, assigns and sponsors for any and all damages that may be sustained and suered by me in connection with my association with or entry or participation in the Gasparilla Distance Classic events. I understand that a physical examination is not required to qualify to run this event and that all competitors participate at their own risk. (If in doubt as to your physical condition to engage in an event as strenuous as these races, it is strongly recommended that you seek the advice of a competent physician.) I also understand that in the event these races cannot be held as scheduled because of an act of God or circumstances beyond control the race is not liable to refund any money paid by me to participate. I release the rights to any and all photographic material, including and computer information the GDCA may wish to release for this event without obligation to me. All persons

under 18 years of age must have written consent of parent or legal guardian to compete in the abovementioned events. I, the undersigned parent or guardian, hereby consent to the applicant's participation and waive and release all rights and claims for damages as is more fully set forth above. I agree to drug testing in accordance with The USA Track and Field and IAAF Rule 144 if I place in the Top 25 overall men and women. I also hereby consent to permit emergency treatment in the event of injury or illness. Gasparilla Distance Classic reserves the right to reject entry.

Signature____________________________________ Parent Guardian (if under 18) ________________________________

Emergency Contact _______________________________________________ Contact Phone ________________________

RACE FEES

 

 

 

POSTMARKED BY 05/31/2016

15K __________________________________________________

$35

5K Run (5 years & older) ______________________________________

$25

5K Walk (5 years & older) _____________________________________

$25

5K Stroller Roll (5 years & older) ______________________________

$25

5K Stroller Roll (children 4 years & under ) ______________________________

$5ea

 

Child Name/Age ______________________________________________________

 

 

Child Name/Age ______________________________________________________

 

 

Child Name/Age ______________________________________________________

 

Gasparilla Half Marathon

_________________________________

$75

Gasparilla 8K ___________________________________________

$30

Michelob Ultra Challenge * _________________________________

$190

(RUN THE 15K, 5K, HALF MARATHON AND 8K)

 

 

 

Michelob Ultra Amber Challenge *

 

 

$160

(RUN THE 15K, 5K AND HALF MARATHON)

 

 

 

 

Michelob Ultra Lime Cactus Challenge *__________________

$90

(RUN THE 15K AND 8K)

*Challenge Jackets are NOT Gender Speci

 

 

 

 

 

 

Jacket Size:___________________________

 

TOTAL AMOUNT DUE:

 

 

$ ___________ __

USAA Military Division (check your branch)

 

 

 

Army

Navy

Marines

Air Force

Coast Guard

National Guard

 

Make checks payable in U.S. funds to: GDCA and mail to:

GD CA, P . O. B O X 1881, T A MPA , FL 33601- 1881

F O R M O R E I N F O R M A T I O N O R T O R E G I S T E R O N L I N E ,

V I S I T W W W . T A M P A B A Y R U N . C O M O R C A L L ( 8 1 3 ) 2 5 4 - 7 8 6 6

ALL E NTR Y FE E S AR E NON- R E FUNDAB LE AND NON TR ANS FE R AB LE .

PLEASE NOTE: If you intend to run more than one distance, you must register and comple te an Entry Form for each . Unless you are running the Michelob Ultra Challenge, Michelob Ultra Amber Challenge or the Michelob Ultra Lime Cactus Challenge, you will be issued a seperate Race Number orf each distance.

PLEASE PRINT LEGIBLY

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