SURGOINSVILLE 10 MILER


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

2/28/2015


Run 8:30am
Skelton Law Racing Series
USATF Course Certification # TN14014MS
SFTC King & Queen Competition, Long Distance Series
First race in 2015 Skelton Law Racing Challenge
Timing and race management by Skelton Law Racing

Pre-registration:
(ends 2/21/2015)
$20
Running club members receive $5 discount if pre-register
| Regular
| Registration:
$30
No Discounts
SFTC King & Queen race: SFTC members receive preregistration discount
Make checks payable to: SURGOINSVILLE 10 MILER
Mail this form to: SURGOINSVILLE 10 MILER
Law Office of Mark Skelton
121 South Depot Street
Rogersville, TN 37857
Scenic out & back certified course on rural paved roads across & along Holston River
Course closes at 2 hours 15 minutes!
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Race Director Mark Skelton
423.345.2335 (home)
423.272.4812 (office)
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