Sullivan County Sheriff's Office Scorpion 5K Run and 2 Mile Walk


Sullivan County Sheriff's Office, Blountville, TN

9/8/2019


6pm - 5K
6:05pm 2 Mile Walk

Pre-registration:
(ends 9/1/2019)
$25 | Regular
| Registration:
$30
Make checks payable to: Friends of the Sullivan County Sheriff's Office
Mail this form to: ATTN: Aaron Hagy
Sullivan County Sheriff's Office
P.O. Box 589
Blountville, TN 37617
Only preregistered participants are guaranteed a shirt. Sizes 3X and 4X t-shirts are available for an additional $2.
Dogs are allowed with proof of vaccination. Owners are responsible for clean-up
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Aaron Hagy
5k@scsotn.com
423-279-6050
Sullivan County Sheriff's Office Scorpion 5K
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
...9,10-19,20-29,30-39,40-49,50-59,60-69,70...
Sullivan County Sheriff's Office 2 Mile Walk
Male & Female Awards:

Top Overall

Age Groups (top 3)

Sullivan County Sheriff's Office Scorpion 5K Run and 2 Mile Walk

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 EVENT: Sullivan County Sheriff's Office Scorpion 5K | Sullivan County Sheriff's Office 2 Mile Walk

*** CIRCLE SHIRT SIZE: XS, 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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