6:00 p.m. Race & Walk Begin |
| Pre-registration: (ends 5/31/2011) |
$12 | | Regular | Registration: |
$15 | |
| Make checks payable to: Clinch River Days Festival | ||||
| Mail this form to: c/o Joyce Kilgore, P.O. Box 127, Saint Paul, VA 24283 | ||||
| Prizes To Be Announced Grandmasters, Masters and Youngmasters Trophies |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Joyce Kilgore 276-971-6464 yellolab@msn.com | Clinch River Days 5.5K Trail Challenge Run Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) ...19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60... | Clinch River Days 5.5K Walk Male & Female Awards: Overall (top 3) No Age Groups |
| 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 EVENT: Clinch River Days 5.5K Trail Challenge Run | Clinch River Days 5.5K Walk |
*** 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) |