|
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___________
_______________________________________________________________
______________________________________________________________
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 This page was last updated on
Thursday, 20 May 2010 08:49 AM | 
P.O. Box 744 