ETSU Physical Therapy 5K Run/Walk

-COURSE MAP-
The Gazebo at the Veterans Administration Campus, Johnson City, TN
Johnson City,TN
8/8/2009
Registration:7:00am. Race begins at 8:00am
Pre-registration:
(ends 8/1/2009)		 $10.00 - preregistration postmarked by 07/28/09. Pre-registered participants are guaranteed a t-shirt! | Regular
| Registration:		 Race-day registration - $15.00
Proceeds will be given to the The Nave Language Center: A Program for Children with Autism and Communication Disorders. . Finish line band-- The Twang Bangers
Mail this form to:
Stephanie Cline
1401 West Lakeview Drive
Johnson City, TN 37601
Make checks payable to
Stephanie Cline
For more info contact
Stephanie Jeter: zscl2@goldmail.etsu.edu 423-502-9819 		ETSU Physical Therapy 5K Run/Walk
Male & Female Awards:



Cash prizes for top male and female overall. Door prizes given away at ceremony!
ETSU Physical Therapy 5K Run/Walk

LAST NAME___________________________ FIRST NAME________________________ M.I.______

SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY______ PHONE (_____)_____-_______

ADDRESS_________________________________________________________________________

CITY________________________________________________ STATE______ ZIP______________

E-MAIL___________________________________________________________________________

RACE DAY EMERGENCY CONTACT (NAME AND PHONE)___________________________________

__________________________________________________________________________________

SHIRT SIZE: 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. DUE TO INSURANCE REGULATIONS, STROLLERS AND HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE______________________________________________ DATE________________
(Parent signature if under the age of 18)

This entry form was generated with the SFTC Calendar Utility at www.RunTriCities.org