Forest Park Step N Stride
- November 11, 2006
Web Entry Form
r 5K Run r 5K Walk r
10K Run - Please Print
Name:___________________________ Age on 11-11-06:______ rMale r Female
Street:_______________________________________________________________________
City:________________________________________State:_____________
Zip:___________
Day Phone:_________________________ Evening Phone:___________________________
E-mail address:
_____________________________________________________________
Team Name ___________________________________________
Long Sleeve T-Shirt size: S
M L XL
XXL
Fees: Pre-registered on or before Nov
4
- No Shirt - $15.00
Pre-registered on or before Nov 4 - with Long Sleeve Shirt - $20.00
After Nov 4 and raceday - $25.00 - includes Long Sleeve Shirt while supplies
last - size not guaranteed.
CHECKS ARE PAYABLE TO: Tuxedo Brothers
Mail completed entry form and entry fee to:
Tuxedo Brothers,
6265 Boone Ridge, Zionsville, IN 46077
RACE PARTICIPATION AGREEMENT:
In consideration of the foregoing, I,
for myself, my heirs, executors and administrators, waive and release any and all
rights and claims for damages I may have against any of the sponsors,
organizers,
City of Noblesville, Tuxedo Brothers, Inc.,
for any and all claims of
damages,
demands or loss actions whatsoever which may arise as a result of my participation in this
event.
I understand and
acknowledge that participating in this walk/run event may expose me to dangers from both
known and anticipated risks.
I attest and verify that I am physically fit and have sufficiently trained for the
completion of this event and my physical
condition has been verified by a licensed medical doctor. Further, I grant full permission
to any and all of the foregoing
to use my likeness for any legitimate purpose whatsoever. I
understand that I will receive a Champion Chip timing device and I must return
it after I complete the event or pay a $30 fee to the organizer.
Signature_______________________________________________ Date __________________
Parent’s or Guardian’s Signature if under age
18__________________________________________ Date ______________
Incomplete/unsigned entries will not be accepted. - Entry form can be copied.
One form per entry please.