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The entry fee is $75 including pledges. You may include this with your registration or bring it the day of the race.

Name:__________________________
Address:________________________
City, State, Zip___________________
Email:__________________________
Phone:__________________________

Male_____ Female______
T-Shirt Size S M L XL
17 years old and under _____
18-50 years old _____
Over 50 years old _____

_____ I will be swimming and will bring a donation the day of the swim.
_____ I will not be swimming but have enclosed a donation

I (signed below), know all the risks associated with participation in any Bell Hospital event. I will not enter unless I am medically, physically, mentally prepared and trained for the activity. I, Myself and anyone entitled to act on my behalf waive and release the entities and sponsors associated with the Teal Lake Swim from any liability.

Signature:___________________________ Parent or Guardian ___________________

Please mail to:
Bell Hospital
c/o Tami Ketchem
901 Lakeshore Drive
Ishpeming, MI 49849
or fax (906) 485-2136
 HR@bellmemorial.org