| Pre-registration: (ends 2/26/10) |
$15 adults $10 kids 18 & under $1 DISCOUNT TO SFTC MEMBERS WHO PRE REGISTER | | Regular | Registration: |
$20 adults $15 kids 18 & under Race Day Registration 7:00 to 7:45 a.m. | |
| SFTC King & Queen race: SFTC members receive preregistration discount | ||||
| Make checks payable to: St. Anne PTO | ||||
| Mail this form to: 300 Euclid Avenue Bristol VA 24201 | ||||
| T shirts to all pre-registered runners and walkers T shirts to all other runners and walkers while supplies last on race day |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Wendy Cheers at St. Anne's School 276-669-0048 | 5k Run for St. Anne School Male & Female Awards: Top Overall Top Masters Top GrandMasters Age Groups (top 3) ...9,10-14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70... | 2 Mile walk for St. Anne School Male & Female Awards: Top Overall Award for top male and top female walkers |
| 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: 5k Run for St. Anne School | 2 Mile walk for St. Anne School |
*** CIRCLE SHIRT SIZE: YS, YM, YL, 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. |
|
SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |