9:00 am 10K (K&Q race) 9:05 Kids mile (KFOM) |
| Pre-registration: (ends 04/30/09) |
$12 - 5K or 10K, run both for $20 $8 - Kids Mile | | Regular | Registration: |
$15 - 5k or 10K both for $20 $8 - Kids Mile | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: ADL | ||||
| Mail this form to: Washington Co. ADL P. O. Box 2099 Abingdon, VA 24212 | ||||
| $100 - 1st Place male/female 10K $50 - 1st Place male/female - 5K |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Debbie Blankenship, home 276-628-9546, work 276-646-4344, cell 276-608-4983 | Animal Chase 10K Male & Female Awards: Overall (top 3) Masters (top 3) GrandMasters (top 3) Age Groups (top 3) Overall winners must be present to accept cash prize | Animal Chase 5K Male & Female Awards: Overall (top 3) Masters (top 3) GrandMasters (top 3) Age Groups (top 3) overall winners must be present to accept cash prizes |
| 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: Animal Chase 10K | Animal Chase 5K |
*** CIRCLE SHIRT SIZE: YM, YL, 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) |