Race 2 Landing 6 Miles


Pickwick Landing State Park, Bethel Springs, TN

1/20/2018


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

Pre-registration:
(ends 1/11/18)
$22.00 with T-shirt
$10.00 with No T-shirt
| Regular
| Registration:
$15.00 with No T-shirt
Mail this form to: Michael D'Orio
88 Harris Dr
Bethel Springs, TN 38315
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Michael D'Orio
Friends of Pickick Landing State Park
88 Harris Drive
Bethel Springs, TN 38315
michaeldorio@hotmail.com
(731)607-9098
Race 2 Landing 6 Miles
Male & Female Awards:

Top Overall
Top Masters
Top GrandMasters

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

Race 2 Landing 6 Miles

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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