11:00 AM (Central Standard Time) Cumberland Mountain State Park |
| Pre-registration: (ends 11/18/232) |
$30.00 Long Sleeve Shirt $15.00 No T-Shirt Day of Race: $ 10.00 No T-shirt | | Regular | Registration: |
$25.00 (No Shirt) | |
| Make checks payable to: Frostbile Running Club | ||||
| Mail this form to: Dan Smithhisler Frostbite Running Club 17 Vanderbilt Rd Mt. Juliet, TN 37122 | ||||
| Headphones are NOT permitted on the course | Strollers are NOT permitted on the course |
| For more info contact Dan Smithhisler Frostbite Running Club 17 Vanderbilt Rd Mt. Juliet, TN 37122 ds1ontherun@hotmail.com 615-290-0121 Reg2Run.com GPS 35.89609 -85.00035 | Plateau Gobbler Gallop 11K Male & Female Awards: Top Overall Age Groups (top 3) ...19,20-29,30-39,40-49,50-59,60-69,70-79,80... |
| 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) |