Welcome: Guest Tuesday, 07 February 2012
Idita-Splash 2012 Entry Form & Site Registration * denotes required data

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:  *
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