| Pre-registration: (ends 9/13/13) |
5K - $20 thru 9/13/12 3K Walk, Kid's Run - Free. T-shirts may be purchased at the race. | | Regular | Registration: |
5K - $25 on 9/15/12 3K Walk, Kid's Run - Free. T-shirts may be purchased at the race. | |
| Make checks payable to: Indian Springs Baptist Church | ||||
| Mail this form to: Fit For The King 5K ISBC 325 Hill Rd Kpt., TN 37664 | ||||
| Packet pick-up and registration: 3:00-4:30 pm. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact David Lovelace, davidlovelace09@gmail.com, 423.956.6604 | Fit For The King 5K Run Male & Female Awards: Top Overall Top Masters Top GrandMasters Age Groups (top 3) 10 under, 11-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+ | 3K Walk or Kid's Mile Male & Female Awards: Age Groups (top 3) Non-competitive walk, medals for kids in youth runs |
| 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 EVENT: Fit For The King 5K Run | 3K Walk or Kid's Mile |
*** CIRCLE SHIRT SIZE: YM, YL, SM, MD, LG, XL, |
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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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |