Fit4Life Glow Run & 80s party


The Wellness Center
200 Med Tech Pkwy #200
Johnson City TN 37604, Johnson City, TN

8/10/2018


8:00 PM start time

Pre-registration:
(ends 8/8/2018)
$25 through August 8th
| Regular
| Registration:
Late Registration
$30 August 9th & 10th
Make checks payable to: MSHA
Mail this form to: Fit4Life 5k Glow Run
Attn:The Goose Chase
3101 Browns Mill Rd, Suite 6-182
Johnson City TN 37604
ONLINE REGISTRATION CLOSES NOON ON WEDNESDAY, AUG. 8th. Late registration will be during Packet Pickup on Thursday (11:30-1:30 p.m.) & Friday (5-7:30 p.m.)
Deadline for guaranteed shirt and shirt-size is July 27th
80’s costume awards: Best Man, Be
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

Fit4Life 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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