AXCS 2005/2006 Km's With Kids Redemption Form

To redeem your form, please print and complete this entire form...make sure an adult AXCS member "certifies" the child's kilometer total...and mail to the AXCS National Office: PO Box 604, Bend OR 97709.

Please allow 2-3 weeks for the award package to arrive via mail. Use a separate form for each child qualifying for an award's packet. One redemption per child between November 2005 and March 2006. Program officially ends on March 31, 2006.


Adult AXCS Member Certification (required!)

I hereby certify that _______________________ (child's name) has skied the kilometer total listed below during the 2005/2006 season and thus qualifies for the Km's With Kids award package (sponsored by AXCS membership).

Current AXCS Member (please print adult's name) __________________________

Signature: __________________________________________ (*see below for legal)


Parental "This Is OK With Me" approval required if the AXCS member above is not the child's parent.

Parent's Signature (if different than above): __________________________________________ (*see below for legal)

Qualification Schedule: (age is based on age as of 12/31/2005)
  • 5 years and under: 25km
  • 6-8 years old: 50km
  • 9-10 years old: 100km
  • 11-12 years old: 200km

Child's Name __________________________________________

Age as of 12/31/2005 _____________________

Number Of Km's Skied During The 2005/2006 Season ___________________________

Parent/Guardian Contact _______________________________ Phone _______________________

Address __________________________________________________________________________

City _____________________________________________ State _____ Zip _________________

Paren'ts Email ____________________________________________________________________________

Local Club & Address (if applicable) ______________________________________________________________

All information provided shall be used exclusively by the AXCS for the purpose of the Km's With Kids program and general membership services. At no point shall this information be bought or provided to commercial or other non-profit interests.

* Legal: Signature of certification by an AXCS member "sponsor" and adult parent/guardian (if different) signifies complete acceptance of risk for participation by the child listed on this form in the sport of cross country skiing. Signature indemnifies and releases AXCS and all members, sponsors, advertisers, contractors, and related parties from any and all liability or claims arising out of participation in the Km's With Kids program or any other participation in the sport of cross country skiing.