Northeast State Honors Glow Run

Northeast State University, Blountville, TN

9/25/2013

8:00pm. Hump Day evening run at Northeast State Community College. Come and do your mid-week run with us at this awesome new event on a fairly flat course (some medium hills). Glo sticks, glo-paint, and anything to light up the night. Very fun event in the middle of the week. Electronic B-tag timing by We Run Events. Stay tuned for more info on this new event.

Pre-registration: (ends 9/24/13)	$20 by 9/24/13	\| Regular \| Registration:	$25 9/25/13
Make checks payable to: Northeast State Foundation
Mail this form to: Northeast State College Foundation, c/o Honors Glow Run, PO Box 246 Blountville, TN 37617

Headphones are permitted on the course | Strollers are permitted on the course

For more info contact
Jane Honeycutt, jbhoneycutt@northeaststate.edu

5K Run/Walk
Male & Female Awards:

Overall (top 3)
Top Masters

Age Groups (top 3)
14U, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+

Northeast State Honors Glow Run

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.

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

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