Results Standard Online Entry Form

1. Fill out Form on your screen 2. Print out 3. Mail in with entry fee

Run (Competitive Runners & Casual Joggers) Walk No Running, Walking Only WheelChair


Last Name First Name .. Male Female ... Age

Birthdate: MM DD YY Adult Shirt Size: Small Med Large X Large XX Large

Address

City State Zipcode

Phone - - - E-Mail

I know that running a roadrace is a potentially hazardous activity and that I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I certify that I have completed the distance that I am registered to run prior to running the race. I, the undersigned, release and forever discharge the management of this race and all agents, representatives, and employees thereof, from any and all claims and damages whatsoever which I, my heirs, their executors, and administrators have or may have against the said Race Management, its agents, representative, or employees by reason of any damages or injuries which may be incurred by myself while running this or any activities sponsored by this race.

Signature: Date:
..................................................................(Signature of parent if entrant is under 18)............................................................................