Rock Island 5 Miler


Rock Island State Park, Rock Island, TN

10/14/2017


Part of the Tennessee State Parks Running Tour
11:00 am (Central Standard Time)
Rock Island State Park

Pre-registration:
(ends 10/05/2017)
$22.00 with T-shirt
$10.00 No T-shirt
| Regular
| Registration:
$15.00 No T-shirt
Mail this form to: Blaine Wilcher
Middle Tenessee Milers
1023 Willow Way
McMinnville, TN 37110
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Blaine Wilcher
Main Street McMinnville
Reg2Run.com
1023 Willow Way
McMinnville, TN 37110
Srereotypeb17@yahoo.com
(931)743-2461
Rock Island 5 Miler
Male & Female Awards:

Top Overall

Age Groups (top 3)
1-12,13-19,20-29,30-39,40-49,50-59,60-69,70-79,80+

Rock Island 5 Miler

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 SHIRT SIZE: SM, MD, LG, XL,

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. STROLLERS ARE NOT ALLOWED ON THE RACE COURSE. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)


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