Race Entry Form
One Hill of a Run 5K and 10K Road Race...Saturday November 14th, 2009
5K RACE STARTS at 9a.m....10K STARTS at 10a.m.
Any Questions Please E-mail to:
Complete and Mail In this Form with Check or Money Order payable to:
Old Farts Running Club, 2010 Woodrun, Lowell, Michigan, 49331
Print Name: __________________________________________
Address: _____________________________________________
City: ____________________State: _____________ Zip:_______
Email Address: ________________________________________
Phone #: ( )_____-_________
Date of Birth: ______________ Age on Race Day:_____ Gender:_________
CIRCLE THE RACE YOU PLAN TO RUN:
5K......Early registration by Nov.1st is $15.00...after Nov.1st/race day...$20.00
10K...Early registration by Nov.1st is $15.00.....after Nov.1st/race day...$20.00
The Double...both the 5K and 10K is $25.00 before Nov.1st...after Nov.1st/raceday...$30.00
T-SHIRT SIZE: SM___MED___LG___XL___
TOTAL AMOUNT ENCLOSED:_______________ check #=___________ money order=_____________
One Hill of a Run Race Waiver: WAIVER MUST BE SIGNED BELOW FOR ENTRY TO BE ACCEPTED. IN REGISTERING FOR THIS RACE OR RACES I STATE THAT I AM FULLY AWARE, UNDERSTAND, AND ASSUME THE RISK AND RESPONSIBILITY FOR PARTICIPATING IN THE RACE ON A COURSE WITH VEHICULAR TRAFFIC AND THAT I HAVE FULLY CONDITIONED MYSELF TO THE APPROPIATE LEVEL OF FITNESS. I ALSO WAIVE ALL CLAIMS AGAINST THE RACE DIRECTORS, HOST SITE, SPONSORS, THE CITY OF GRAND RAPIDS, ETC. I AM ALSO AWARE OF THE FACT THAT IF THE RACE GETS CANCELLED DUE TO WEATHER OR OTHER UNFORE SEEN REASONS THAT THE RACE ENTRY IS NON-REFUNDABLE.
SIGNATURE:___________________________________DATE:____________________________
PARENT or GUARDIAN MUST SIGN IF UNDER 18 YEARS OF AGE:
SIGN:__________________________________________DATE:____________________________