SURGOINSVILLE 10 MILER


Surgoinsville Middle School
1044 Main Street (just off Highway 11W west of Kingsport), Surgoinsville, TN

2/25/2017


Run 8:00am
Skelton Law Racing Series
2017 RRCA Tennessee State 10 Mile Championship
Race day registration allowed!
Taco Bar by Barberitos of Kingsport!
SFTC King & Queen Competition and Long Distance Series
USATF Course Certification # TN14014MS
First race in 2017 Skelton Law Racing Challenge
Timing and race management by Skelton Law Racing

Pre-registration:
(ends 2/11/2017)
$25
SFTC members receive $5 discount if pre-register
| Regular
| Registration:
$40
No Discounts
SFTC King & Queen race: SFTC members receive preregistration discount
Counts towards SFTC Long Distance Series
Make checks payable to: Skelton Law Racing
Mail this form to: Surgoinsville 10 Miler, Law Office of Mark Skelton, 121 S. Depot Street, Rogersville, TN 37857
Scenic out & back certified course on rural paved roads along Holston River. Course closes at 2 hours 30 minutes!
For additional lunch tickets, submit guest name & $10.00 per guest with race entry.
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Race Director Mark Skelton
423.272.4812 (office)
423.345.2335 (home)
markskelton@markskelton.com
SURGOINSVILLE 10 MILER
Male & Female Awards:

Top Overall
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...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...

SURGOINSVILLE 10 MILER

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