|
| PRINT an ADOBE
PDF copy of this form to fill out and send
in. 
Mountain
Home Marathon
Nov, 21, 2009 Mountain Home
High School
8 a.m. Rain or shine
Last Name
______________________________________ First Name
___________________
Date of Birth
____/____/____ Age on Race Day
_________ M
_____ F ______
Street
________________________________________________________________________
Town
_________________________________________ State
________ Zip_______________
Email:_________________________________________________________________________
Marathon ________ $60
after
Nov 7th $70 Nov 21st $80
Half
Marathon
_____ $45 after
Nov
7th $55 Nov 21st $65
5K
______
$20 after
Nov 7st $30 with no extra charge for race day
registration
All entrants and families are invited to a
post race, potluck dinner provided by the local
churches.
Circle Shirt Size:
Adult: S M
L XL
XXL
Gourmet Primo Pasta Dinner
- 5:30-7:00 Nov 20th - Adults
$10.00 Children $5.00
Number of Adults ______ Number of
Children ______ Meatless
preferred_____
Pasta dinner provided by Mary Jo and her
daughter Jameeo Traver, a grad of the Seattle Culinary
Institute.
Release:
I know that running and
volunteering to work in club races are potentially hazardous
activities. I should not
enter and
run in this race
unless I am medically able and properly trained. I agree to abide by
any decision of
a race official relative to my
ability to safely complete the run. I assume all risks associated
with running and
volunteering to work in club races
including, but not limited to falls, contact with other
participants, the effects
of the weather, including high
heat and/or humidity, the conditions of the road and traffic on the
course, all
such risks being known and
appreciated by me. Having read this waiver and knowing these facts,
and in
consideration of your accepting my
entry, I, for myself and anyone entitled to act on my behalf, waive
and release
the Mountain Home Marathon, City
of Mountain Home, and all sponsors, their representatives and
successors
from all claims or liabilities of
any kind arising out of my participation in the race and/or club
activities even
though liability may arise out of
negligence or carelessness on the part of the persons named in this
waiver.
I grant permission to all the
foregoing to use any photographs, motion pictures, recordings, or
any other record
of this event for any legitimate
purpose.
Signature________________________________________________________
Date ___________________
(Parent’s signature if
minor)
Mail application and payment
to:
Mountain Home Marathon
Laurie Kasinger
445 CR
1008
Mountain Home, AR
72653 |
