5K RUN TO THE CORN APPLICATION

NAME:___________________________________________________________________

 

ADDRESS:_______________________________________________________________

 

DAY PHONE:_____________________________________________________________

 

AGE ON APRIL 23, 2011:______________________MALE:_______FEMALE:_______

 

T-SHIRT SIZE:

ADULT SIZE:  _____S ______M______L_______XL_______

 

KIDS SIZE: ______YM ______YL

 

DATE:_____________________________________AMT. ENCLOSED:____________

 

 

Early registration.....$15.00 thru April 18, 2010

 

Late registration.....$20.00

 

Line up is in front of the First Baptist Church on Mitcham St. in Malakoff.  Start time is 8a.m.  Packets and t-shirts will be available on race day starting at 7a.m.

Awards will be given to the following age groups:  14 and under, 15 - 16, 17 - 19, 20 - 29, 30 - 39, 40 - 49, 50 - 59, 60 - 69, 70 and over

 

GENERAL RULES OF LIABILITY:  In consideration of my signed entry, I waive my rights and claims for damages against the sponsors and producers of this event.

I attest I am physically fit and I understand the fees are non-refundable.  This entry in invalid unless siged by entrant.  If entrant is under 18 years of age, parent

or guardian my sign entry.  On entry per form, copies accepted.

 

SIGNED:_____________________________________________________________DATE:________________________

 

PARENTS SIGNATURE:_________________________________________________