| Official Entry Form 2008 ICE Breaker Open Water Swim Saturday, April 5, 9am start 1/2 mile swim Granite Beach, Folsom Lake, Granite Bay, CA |
| Last Name: | ______________________ | Street Address: | ___________________________________ | |||
| First Name: | ______________________ | City, State ZIP: | ___________________________________ | |||
| Gender: | Male Female | Phone: | ___________________________________ | |||
| Date of Birth: | ______________________ | Email: | ___________________________________ | |||
| Race Day Age: | ______________________ | Team/Club: | ___________________________________ |
| Category: |
| Individual 1/2 mile |
| Category: | Before Race Day : | On Race Day: | (including pancake breakfast) | |
| Individual | $25 | $35 |
| Total Body Fitness 5209 Blaze CT. Rocklin, Ca 95677 |
Make checks payable to: TOTAL BODY FITNESS Total Amount Enclosed: $_____________ |