| Pre-registration: (ends 4/23/10) |
$15 until April 23rd. Only pre-registered runners will be guaranteed a shirt! | | Regular | Registration: |
$20 after April 23rd. Registration will close at 8:30 the day of the race. | |
| Make checks payable to: Boys to Men | ||||
| Mail this form to: PO Box 4426 Johnson City, TN 37602 | ||||
| Cash prize for overall 1st place male and female and shoe tag timing! Check out our new course for this year! Prize for 1st place dog will be awarded this year! Only preregistered runners are guaranteed a shirt! There will be a dog rac |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact randy almanzor 423-610-1242 | Run The Gump 5k Male & Female Awards: Overall (top 2) Sen.GrMasters (top 2) Age Groups (top 2) ...10, 11-15,16-20,21-30,31-40,41-50,51-60,60... |
| 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 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) |