Chickasaw Chase Quarter Marathon


Chickasaw State Park, Jackson, TN

11/18/2017


Part of the Tennessee State Parks Runner Tour
Chickasaw State Park
11:00 AM (Central Standard Time)

Pre-registration:
(ends 11/913/2017)
$22.00 with T-shirt
$10.00 with No T-shirt
| Regular
| Registration:
$15.00 with No T-shirt
Make checks payable to: Frostbite Running Club
Mail this form to: Lisa Bell
1900 Liberty Rd
Camden, TN 38320
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Lisa Bell
Frostbite Running Club
Reg2Run.com
1900 Liberty Rd
Camden,TN 38320
lisa.bell@bcos.org
731-441-1469
Chickasaw Chase 10 Miles
Male & Female Awards:

Top Overall
Top Masters

Age Groups (top 3)
10-14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70-74,75-79,80

Chickasaw Chase Quarter Marathon

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)


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org