11th Annual FIRECRACKER 4 MILER


Rogersville City Park, 331 Park Boulevard, Rogersville, TN

7/4/2015


Run 7:00AM
USATF Course Certification # TN14063MS
Skelton Law Racing Series
SFTC King & Queen Competition
Rogersville 4th of July Celebration Event
Pool party for race participants
Timing and race management by Skelton Law Racing
Entry fee for SFTC members is *only $10* if pre-register.

Pre-registration:
(ends 6/27/2015)
$15
Running club members receive $5 discount if pre-register
| Regular
| Registration:
$20
No Discounts
SFTC King & Queen race: SFTC members receive preregistration discount
Make checks payable to: FIRECRACKER 4 MILER
Mail this form to: Firecracker 4 Miler, Law Office of Mark Skelton, 121 South Depot Street, Rogersville, TN 37857
Course closes at 60 minutes.
Certified loop course through historic downtown Rogersville.
Stay for FREE Rogersville 4th of July Celebration with great concerts, fireworks & more
Headphones are NOT permitted on the course | Strollers are NOT permitted on the course
For more info contact
Mark Skelton
423-345-2335(home)
423-272-4812(office)
markskelton@markskelton.com
FIRECRACKER 4 MILER
Male & Female Awards:

Top Overall
Top Masters
Top GrandMasters
Top Sen.GrMasters

Age Groups (top 3)
...9,10-14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70-74,75-79,80...

11th Annual FIRECRACKER 4 MILER

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. 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)


This entry form was generated with the SFTC Calendar Utility at www.runtricities.org