Inaugural Glow Run 5K


Elizabethton High School Track, 907 Jason Witten Way * Elizabethton TN 37643, Elizabethton, TN

6/20/2014


9pm. The race will be in conjunction with the Relay For Life of Carter County. Join us before and after for food, entertainment, and family friendly fun – all to benefit the American Cancer Society! Those registered by May 31 will be guaranteed a t-shirt.

Pre-registration:
(ends 5/31/14)
$15 | Regular
| Registration:
$25
Make checks payable to: American Cancer Society
Mail this form to: Kristi Smith | 5 K Organizer
American Cancer Society, Inc.
508 Princeton Road, Suite 102
Johnson City, TN 37601
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Kristi Smith, smitkl01@mail.etsu.edu
Glow Run 5K
Male & Female Awards:



Age Groups (top 3)
To Be Determined

Inaugural Glow Run 5K

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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