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LOCAL

REGISTRATION PACKET

 2nd Annual

Mountain Heritage High School

Relay For Life

5K run /walk

Friday

June 18, 2010

8:30 am

At: Mountain Heritage High School

ENTRY FEES:

·$25 just call and I will pick up form and fees (423-647-2543) or (828-682-4940)

·$30 Day of race

·Packet can be mailed or faxed to you or can be picked up at Buchanan Tax Svc 66 Ida Ln Burnsville

·Day of race 7:30-8:30 AM

·Short sleeved race shirts guaranteed to 1st 200 runners

·NO PETS OR BABY JOGGERS ALLOWED ON COURSE

 

AWARDS:

Trophies for 1st – 3rd  Overall, Men and Women

Medals for Top 3 Males & Females in each age group

Age Groups: 

15-18                             36-45

19-25                            46-55

26-35                                        56 & over                                                                            

 Mail In Registration:                                                              

Send to:                                                                                               

Kimberly Wilson-Hopkins                                                                       

Relay For Life Fun Run

461 Ewart Wilson Road

Burnsville, NC  28714

Waiver of Liability

Please Read & Sign In consideration of the acceptance of the entry, I for myself, my heirs, and assigns, hereby release the sponsors, race workers, and officials of this race from any and all liability arising from illness and damages I may suffer as a result of participation in such event. I fully assume and understand the risks of voluntarily participating in this race, including death, or injury due to vehicles, falls, collisions with participants or spectators, actions by hostile humans or animals, uneven pavement, obstructions adverse weather, sudden illness or any other risk. I attest that I am physically fit and have sufficiently trained for this event and am aware that participation in any of these events could, in some circumstances, result in severe physical soreness or injury.  I authorize run officials to provide medical attention at my expense should I appear in need.  For injuries I sustain including death I hereby waiver, Yancey County School,  and anyone connected with this event from any claim or lawsuit that may be brought at any time by me, my family, estate, or heirs arising from my voluntary participation in this event. I also give permission for free use of my name and picture in any broadcast/telecast or written account of the event. I understand that the entry fee I pay is NON-REFUNDABLE.  I have read this agreement and pay the entry fee in exchange for the privilege of participating under the conditions of this agreement.

 

___________________________________                       __________________________

Signature  {if under 18 Parent or Guardians}                                                                     Date

 

Name _________________________________________________

            First                                                                  Last

 

Age on the date of race ______________  Sex: Male / Female                    t-shirt size ___________

Emergency Contact Information

Street Address:__________________________     
City / Town        Zip Code                        
Name of Person to be contacted & relationship to you___________             _______________________________________________________________

______________________________________________________________

 Home Phone to include area code       Phone # s  Cell   & home

 

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This page was last updated on Thursday, 20 May 2010 08:49 AM


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