Our 3rd annual race. Note that the this is now a 5K and not a 5 Mile race. Dont miss all our door prizes, great shirts and Cool Awards!!! Electronic D-tag ("chip") timing will be used. Race size limit: 400 |
| Pre-registration: (ends 5/1/2010) |
$20 - 5K 4 Person teams must send in forms together. | | Regular | Registration: |
$25 - 5K No day of Race Team registration | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: Foot Rx | ||||
| Mail this form to: Foot Rx 5K 3135 Peoples Street Suite 404 Johnson City, TN 37604 | ||||
| $1 discount to SFTC Members/Wellness Center Members Only preregistered runners are guaranteed Tech Tee! Clydesdale division (men over 200lb) Athena division (women over 150lb) Need to circle here!!! |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Steve 423 282 2235 steve@footrx.com | Foot Rx 5K Male & Female Awards: Overall (top 3) Masters (top 2) Top GrandMasters Age Groups (top 3) ...9,10-14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65... |
| 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)_________________________________________ |
TEAM NAME____________________________ |
*** CIRCLE SHIRT SIZE: XS, 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) |