Alpha Xi Delta's Light It Up Blue 5K


ETSU Main campus at the CPA.
1244 Jack Vest Dr, Johnson City, TN 37614, Johnson City, TN

4/13/2019


7pm-5K start time

Results

Pre-registration:
(ends 4/12/2019)
$35- adult 5K, $25-14yo. and under 5K (includes t-shirt) | Regular
| Registration:
$40-adult 5K, $30-14yo. and under (t-shirts only if available)
Make checks payable to: Alpha Xi Delta
Mail this form to: 302 Princeton Rd. Apt. 21, Johnson City, TN, 37087
Help us raise money For Autism Speaks! Only preregistered runners are guaranteed a shirt!
Headphones are NOT permitted on the course | Strollers are permitted on the course
For more info contact
Hannah Gatlin, gatlin@etsu.edu, 615-707-9301
Alpha Xi Delta's Light It Up Blue 5K
Male & Female Awards:

Overall (top 3)
GrandMasters (top 3)

Age Groups (top 3)
14 and under, 15-19, 20-29, 30-39, 40-49, 50+

Alpha Xi Delta's Light It Up Blue 5K

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

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


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