| | Regular | Registration: |
$55 (Jan. 1-March 31) $60 (April 1-June 30) $65 (July 1-September 19) | |||
| Make checks payable to: City of Norton | ||||
| Mail this form to: City of Norton, C/O Katie Dunn, P.O. Box 618, Norton, VA 24273 | ||||
| Runners that pre-register by September 8 will be guaranteed a race shirt. Part of the High Knob Triple Crown Series (www.highknobtriplecrown.wix.com/hktc. |
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Katie Dunn: katied@nortonva.org or (276) 679-1160 | Mountain Fork Half Marathon Male & Female Awards: Overall (top 3) Top Masters Age Groups (top 3) 29 & Under; 30-39; 40-49; 50-59; and 60 and over |
| 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, 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. |
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SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |