| Pre-registration: (ends 11/11/2022) |
$25 through Feb 28 $30 Mar 1 - June 30 $35 July 1 - Nov. 11 Kids 6 & under -$15(t-shirt,bib,medal(with bib) - not timed, no award | | Regular | Registration: |
Late Registration $40 Nov. 12 at packet pickup 2-4 p.m. | |
| Make checks payable to: The Smores Run Knoxville | ||||
| Mail this form to: The Smores Run Knoxville 3101 Browns Mill Road, Suite 6- #182 Johnson City, TN 37604 | ||||
| CIRCLE HERE FOR 3XL SIZE OPTION CIRCLE WAVE START by your mile time Wave 1(5:01 - 9) - WAVE 2(9:01-11) - WAVE 3(11:01-13) WAVE 4(13:01-16) - WAVE 5(16:01-20) - WAVE 6(>20:01) |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact The Goose Chase (423)946.0519 info@thegoosechase.org | 5k Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) 9 & Under, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 & Older |
| 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: YM, YL, SM, MD, LG, XL, XXL |
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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) |