Splasher Information	Entry Fee: $25 ($30 for 2X+) or $50 ($55 for 2X+)

		for help on registration data requested, mouse-over the labels below

First Name:	*
Last Name:	*
Organization or Group:
Email Address:	*
		Note: We will not share your email address with any third party.
Site Password:	*
Confirm Site Password:	*
Shirt Size:	*	*Choose Size* Small (S) Medium (M) Large (L) X-Large (XL) 2X-Large (2XL) 3X-Large (3XL) 4X-Large (4XL)
Address 1:	*
Address 2:
City:	*
State or Province:	*
Country:
Postal Code:	*
		Note: Please include dashes for US 9 digit zip codes (ex. 10001-1001)
Phone:
Waiver Initials:	*	Mailing or faxing? Sign here --->
SPECIAL REMINDER: If you log online there is no need to fax, email, or mail your log sheet (done automatically).
		Note: By initializing the box above, I hold harmless and indemnify the sponsors of this event from and against any and all liability and damages for any and all personal injuries, deaths, and/or property damage caused by my participation in the 2012 Idita-Splash.
		Mailing, scanning, or faxing?  Print-complete-send using the contact information below: Idita-Splash 2012 P.O. Box 776 Nome, AK  99762 email: contactus@idita-splash.org fax: 907.443.5919