All proceeds go towards the Christopher Todd Richardson Memorial Scholarship Technical fiber shirt. One of a kind awards handmade pottery by a local artist for overall awards Brooks hat's and tech T's and Nathan bottles as doorprizes |
| Pre-registration: (ends 08/01/10) |
$20.00- 10K run $15.00- 2 mi walk | | Regular | Registration: |
$25.00- 10K Run $15.00- 2 mi walk | |
| Make checks payable to: Christopher Todd Richardson Memorial Scholarship | ||||
| Mail this form to: Christopher Todd Richardson Memorial 10K, 15191 Big Knob, Bristol, VA 24202 | ||||
| Only preregistered runners & walkers are guaranteed a (technical fiber) shirt!! ALL proceeds benefit the Christopher Todd Richardson Memorial Scholarship Fund * One of a kind trophies!! * AWESOME door prizes! * |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Jenny Nichols- race director 276-619-1489 | 10K Run Male & Female Awards: Overall (top 3) Masters (top 3) GrandMasters (top 3) Age Groups (top 3) ...19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60... | 2 Mile Walk Male & Female Awards: no placing in walk... all walkers will receive a shirt with entry fee |
| 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: 10K Run | 2 Mile 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) |