Ultramarathon Q50 Finca Las Nubes, Nicaragua, Trail Run

REGISTRATION CLOSES SEPTEMBER 30th, 2007

Entry Fee
Solo 50 Miles: USD 60.
Team 2x25 Miles Relay: USD 80 (per team).

NOTE: No refunds after September 1st 2007.

Part of the proceeds of the race will be donated by Q50 Races to a Medical Clinic of a small village called El Jobo. This humble medical clinic provides medical assistance to the locals.

PAYMENT:
**BY MAIL: Please send a check on the name of Interquest Exports and Imports Inc. and enclose a signed and completed entry form to:

618 W. Aspinwall Rd.
Winslow, AZ 86047
Phone number: 520-820-0598
U.S.A.

You will receive an entry payment confirmation by return.

**ONLINE AND WIRE TRANSFER: Please, complete the registration form online you will find following. Then, contact us info@q50races.com, we will send you the details of our USA Bank Account so you can wire us the entry fee. Please, remember to use your Name and Last Name as a wire transfer reference so we can trace it at our end and identify it as yours.

I want to register for?

Your Name and Last name (*)

Your email (*)

Phone number (*)

Address (*)

ZIP Code (*)

City/State and Country (*)

Birth Date

Age

Passport number or D.N.I.:

Medical Insurance

Medical Insurance Phone (and # if necessary)

T-shirt size

Please list below any medical or physical condition(s) that should be noted by the Medical Director. Please describe any medical/physical conditions that may affect your ability to safely take part in this event and list any medications that you are routinely taking. Also please mention if you are allergic to any insects, or medicines. List N/A if no conditions exist.

Name and telephone number of relative or friend who can be called in case of emergency:

Name and telephone number of relative or friend who can be called in case of emergency 2:

The Other Team Member Information.

Your Name and Last name (*)

Your email (*)

Phone number (*)

Address (*)

ZIP Code (*)

City/State and Country (*)

Birth Date

Age

Passport number or D.N.I.:

Medical Insurance

Medical Insurance Phone (and # if necessary)

T-shirt size

Please list below any medical or physical condition(s) that should be noted by the Medical Director. Please describe any medical/physical conditions that may affect your ability to safely take part in this event and list any medications that you are routinely taking. Also please mention if you are allergic to any insects, or medicines. List N/A if no conditions exist.

Name and telephone number of relative or friend who can be called in case of emergency:

Name and telephone number of relative or friend who can be called in case of emergency 2:

WAIVER:
I hereby confirm that I have read the Q50 Patagonia Race Rules and Regulations and voluntarily sign this waiver. I confirm my agreement to assume the entire risk of any loss, property damage, illness, injury, contact with other participants, damages caused by weather conditions and geographical obstacles, or death that I may sustain or cause as a result of my participation on the Q50 Finca Las Nubes, Nicaragua (the “Event”). I understand that my participation in the Event may include participation in activities which demand a very high level of skill and physical and mental fitness. I confirm that I register on the Event declaring to be medically able and properly trained. I hereby assume responsibility to follow any decision given by an organization official or doctor relative to my ability to complete the race. Having read this text and having acknowledged possible consecuences and considering my acceptance in participating in the Event, I hereby, under my name and under any person that may represent me, release and discharge Q50 Patagonia Organizers, local authorities related to the event and all Oficial Sponsors that intervene in the Event, contractors, representatives and successors, from present and future claims and liabilities of any kind, known or unknown, arising out of my participation on this event or related activities, even though such claim or liability may arise out of negligence or fault on the part of any of the forgoing persons or entities. I grant permission to the foregoing persons or entities to use any photographs, motion pictures, recordings, or any other record of my participation in this event for any legitimate purpose without remuneration.

Thank you!

Entry is non-transferable.
No race day entries.
If you have any question regarding your registration or payment options, do not hesitate to contact us. Q50 Races also has bank accounts available in Mexico, Argentina, Uruguay, and Nicaragua.