CARMI 5K Race2Recovery


Veteran's Administration Mountain Home Campus, Johnson City, TN

9/29/2012


Sign-In/Registration: 8:30 AM; Race: 9:00 AM
Location: Start & finish on the VA Medical Center campus, near the gazebo.
Race will precede CARMI-sponsored & VA-hosted Jammin' at the VA

CARMI is an advocacy group whose mission is to educate the Upper East TN region about mental illness and recovery from mental illness. We offer education, hope and resource information to persons with mental illness, their family members, co-workers and friends.


Pre-registration: $20 - Registration by 9/10/12
(Group discount available)
| Regular
| Registration:
$25 - Registration after 9/10/12
Make checks payable to: CARMI
Mail this form to: Natalie Honeycutt; 102 Stonewall Jackson Dr; Unit 6; Elizabethton, TN 37643
Cash prize - 1st place overall M/F. T-shirt guaranteed to pre-registered. Only registered participants eligible for prizes. No fee for walkers - donations appreciated. ALL participants must sign race waiver.
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Carol Kardos 423-929-0710 (Leave Message)
CARMI RACE TO RECOVERY
Male & Female Awards:

Top Overall

Age Groups (top 3)
...19,20-29,30-39,40-49,50-59,60...

CARMI 5K Race2Recovery

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, XXL

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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