SURGOINSVILLE 10 MILER

-COURSE MAP- -DIRECTIONS-
Surgoinsville Middle School
(on Main Street/Highway 346 off Highway 11W west of Kingsport)
Surgoinsville,TN
2/27/2010
Run 9:00am
USATF#TN03004RH
SFTC King & Queen Competition
SFTC Long Distance Series
Skelton Law Running Series
Pre-registration:
(ends 2/20/2010)		 $17
SFTC members receive $2 discount if pre-register		 | Regular
| Registration:		 $25
No Discounts
King/Queen race: SFTC members receive prereg. discount
Scenic out & back certified course on rural roads across & along Holston River
Course closes at 2 hours 15 minutes
Mail this form to:
SURGOINSVILLE 10 MILER
Law Office of Mark Skelton
121 South Depot Street
Rogersville, TN 37857
Make checks payable to
SURGOINSVILLE 10 MILER
For more info contact
Mark Skelton
423-345-2335(home)
423-272-4812(office)
markskelton@markskelton.com 		SURGOINSVILLE 10 MILER
Male & Female Awards:
Top Overall
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70-74,75-79,80...
SURGOINSVILLE 10 MILER

LAST NAME___________________________ FIRST NAME________________________ M.I.______

SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY______ PHONE (_____)_____-_______

ADDRESS_________________________________________________________________________

CITY________________________________________________ STATE______ ZIP______________

E-MAIL___________________________________________________________________________

RACE DAY EMERGENCY CONTACT (NAME AND PHONE)___________________________________

__________________________________________________________________________________

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. DUE TO INSURANCE REGULATIONS, STROLLERS AND HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE______________________________________________ DATE________________
(Parent signature if under the age of 18)

This entry form was generated with the SFTC Calendar Utility at www.RunTriCities.org