Anna Cooper Memorial 3.0 mile Fun Run/1.5 mile Walk, NO AWARDS!!


Whitetop Creek Park, Bristol, TN
310 Sportsway Drive
Bristol, TN 37620
, Bristol, TN

10/19/2019


7:30 AM- T-shirt pick up
8:30 AM- Run/walk start

Pre-registration:
(ends 10/2/19)
$15.00 Donations can be mailed to Jennifer Cooper 396 Tim Warren Rd., Bristol, TN 37620
or sent via VENMO to @DanielWilliamson-01.
Please include contact information and shirt size with donation.
sent via VENMO to @DanielWilliamson-01.
| Regular
| Registration:
$15 made the day of the run/walk
will receive a t-shirt while supplies last
Make checks payable to: TTU Athletics; memo: BackPack Buddies
Mail this form to: Jennifer Cooper
396 Tim Warren Rd., Bristol, TN 37620
Anna was instrumental in the creation and success of a program named
Backpack Buddies that served underprivileged youth in the Cookeville, TN community.

Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
Jennifer Cooper
396 Tim Warren Rd., Bristol, TN 37620
tjcoop@btes.tv
423-366-2885
Anna Cooper Memorial 3.0 mile Fun Run/1.5 mile Walk NO AWARDS
Male & Female Awards:




...19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60...

Anna Cooper Memorial 3.0 mile Fun Run/1.5 mile Walk, NO AWARDS!!

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,

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.

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


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