13th Annual Milligan Buffalo 5K (& 2.5K walk)


Milligan College - Steve Lacy Fieldhouse, Milligan College, TN

10/24/2015


9:00 am

Pre-registration:
(ends 10/18/15)
$20 | Regular
| Registration:
$25
Make checks payable to: Milligan College - ALM
Mail this form to: John Simonsen
PO Box 500
Milligan College 37682
Headphones are permitted on the course | Strollers are permitted on the course
For more info contact
John Simonsen (423) 975-8031
5K Run
Male & Female Awards:

Overall (top 3)

Age Groups (top 3)
...14,15-19,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,70...
2.5K walk
Male & Female Awards:




none

13th Annual Milligan Buffalo 5K (& 2.5K 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: 5K Run | 2.5K walk

*** 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)


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