Runnin' for Research 5k Run & 1 Mile Walk for Headache and Migraine Research


Warriors' Path State Park, Kingsport, TE

9/29/2018


Registration at 8:00 am / Run & Walk Starts at 9:30 am

| Regular
| Registration:
$20 Individual Age Group/Open
$20 1 Mile Walk- Noncompetitive
$20 Virtual Runner
Mail this form to: 2517 John B Dennis Hwy
Kingsport, TN 37660
Headphones are NOT permitted on the course | Strollers are permitted on the course
For more info contact
Daniel Henninger
st.dominics.youth@gmail.com
Runnin' for Research 5k Run & 1 Mile Walk for Headache and Migraine Research
Male & Female Awards:

Overall (top 3)
Masters (top 3)
GrandMasters (top 3)

Age Groups (top 3)
...13,14-23,24-33,34-43,44-53,54-63,60...

Runnin' for Research 5k Run & 1 Mile Walk for Headache and Migraine Research

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: XS, 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. PARTICPANTS USING HEADPHONES ARE NOT ALLOWED ON THE RACE COURSE.

SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18)


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