| Pre-registration: (ends 10/15/2010) |
$ 19.00 (Long sleeve T-shirt) $ 17.00 (SFTC member with shirt) $ 6.00 (No shirt) $ 4.00 (SFTC member no shirt) | | Regular | Registration: |
$ 13.00 (No shirt) $ 25.00 (With shirt available) No discount on race day registration | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: SFTC | ||||
| Mail this form to: Roan Mountain 10K, c/o Rob Schoborg, 623 W. Maple Street, Johnson City, TN 37604 | ||||
| ***ONLY PRE-REGISTERED RUNNERS ARE GUARANTEED A T-SHIRT *** *** No Refunds *** Chili lunch after the race! *** |
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Rob Schoborg (423) 439-6295 (423) 926-1265 schoborg@etsu.edu | Roan Mountain 10K Run Male & Female Awards: Top Overall Top Masters Top GrandMasters Top Sen.GrMasters Age Groups (top 3) ...19,20-29,30-39,40-49,50-59,60... |
| LAST NAME__________________________________ FIRST NAME_________________________ M.I._______ |
SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________ |
ADDRESS___________________________________________________________________________ |
CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________ |
RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________ |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, |
|
IN CONSIDERATION FOR ACCEPTING MY ENTRY IN THIS RACE, I FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN SAID RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |