Pre-registration: (ends 6/16/2023) |
$25 through February 28 $30 March 1 through June 16 | | Regular | Registration: |
$35 June 17 at packet pickup | |
Make checks payable to: Make A Wish Foundation NOTE: Johnson City | ||||
Mail this form to: Run For Wishes 3101 Browns Mill Rd Suite 6-182 Johnson City TN 37604 |
Don't forget to dress up for the costume contest! Circle here for 3XL shirt size |
Headphones are permitted on the course | Strollers are permitted on the course |
For more info contact info@thegoosechase.org | 5k Male & Female Awards: Overall (top 3) Top Masters Top GrandMasters Age Groups (top 3) 9 & under, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+ |
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: YS, YM, YL, 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. |
SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |