Packet Pickup Saturday, March 20 at 3 p.m. ETSU campus **Finisher medal to first 250 registered participants only** |
| Pre-registration: (ends 03/05/2021) |
Pricing $25 Early bird special (now through February 5) $30 per entrant (February 6 through March 19) 18 & under $20 Early bird special (now through February 5) $25 per entrant (February 6 through March 19) | | Regular | Registration: |
$35 Late registration (Packet Pickup on March 20) $30 Late registration (Packet Pickup on March 20) | |
| Make checks payable to: Southern Appalachian Ronald McDonald House (SARMHC) | ||||
| Mail this form to: Shamrock Shuffle 3101 Browns Mill Rd Suite 6-182 Johnson City TN 37604 | ||||
| Costume Contest - Best male, female, boy, girl & group No post race. See website for Covid procedures. |
| Headphones are permitted on the course | Strollers are permitted on the course |
| For more info contact Karen or Ashley info@thegoosechase.org 423.946.0519 | Shamrock Shuffle 5k Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) Age Groups Top 3 Male & Female (9 & Under, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70 & Older) |
| 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 |
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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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |