Part of the Tennessee State Parks Running Tour In Fall Creek Falls State Park |
| Pre-registration: (ends 2/28/2010) |
$18.00 (Shirt) $5.00 No Shirt | | Regular | Registration: |
$12.00 (No Shirt) | |
| Make checks payable to: Mach Tenn. | ||||
| Mail this form to: 210 Lakewood Dr. Tullahoma, TN | ||||
| Part of the Tennessee State Parks Running |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Bob & Aggie Alt / Mach Tenn.org 210 Lakewood Dr Tullahoma, TN Realt@charter.net 931-455-3986 | The Fall Creek Thaw 15K Male & Female Awards: Top Overall Top Masters Top GrandMasters Top Sen.GrMasters Age Groups (top 3) ...19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70-74,75... |
| 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, |
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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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |