5k Glow Run & 80s party


The Wellness Center
200 Med Tech Pkwy #200, Johnson City, TN

8/9/2019


8:00 PM start time

Pre-registration:
(ends 8/7/2019)
$25 through August 7th
| Regular
| Registration:
Late Registration
$30 August 8th & 9th
Make checks payable to: Ballad Foundation *Memo - 5k Glow Run
Mail this form to: 5k Glow Run
3101 Browns Mill Rd, Suite 6-182
Johnson City TN 37604
ONLINE REGISTRATION CLOSES 9 P.M. ON WEDNESDAY, AUG. 7th. Late registration will be during Packet Pickup on Thursday Aug 8th (11:30-1:30 p.m.) & Friday Aug 9th (5-7:30 p.m.)
Deadline for guaranteed shirt and shirt-size is July 26th
Costume Contest
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
The Goose Chase
(423)946-0519
info@thegoosechase.org
5k Glow Run
Male & Female Awards:

Overall (top 3)
Top Masters
Top GrandMasters

Age Groups (top 3)
9 & Under, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 & Older

5k Glow Run & 80s party

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: YM, YL, 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. 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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