| Pre-registration: (ends 4/19/2010) |
5k-$15.00 half-marathon-$20.00 | | Regular | Registration: |
5k-$20.00 half-marathon $25.00 | |
| Make checks payable to: Rittenhouse Memorial Fund | ||||
| Mail this form to: Harriman Police Dept/Marathon p.o.Box 433 Harriman, Tn 37748 | ||||
| This race funds the police unity tour, and other police oriented youth events. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Karen Joseph, Harriman Police Dept. 865-882-3383 kjoseph@harrimanpolicedept.com | 13k Male & Female Awards: Top Overall Age Groups (top 2) ...19,20-29,30-39,40-49,50-59,60... | 5k Male & Female Awards: Top Overall Age Groups (top 2) ...19,20-28,29-37,38-46,47-55,56-64,60... |
| 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 EVENT: 13k | 5k |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, XXL |
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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) |