Fitness Five

August 26, 2010

Cancer Fund Raiser

PLEASE PRINT(One person per entry form – copies accepted)

 Mail to Jimmy Crossett

417 BROWNING  AVE.

HUNTINGDON, TN   38344 

 
Name  
 
Email      
 
Address  
 
City       
 
State & Zip
 
Phone      

Circle gender and age Group on race day. MALE            FEMALE

0-10   11-19   20-24   25-29   30-34   35-39   40-44   45-49   50-54   55-59   60 and up          

T-Shirt size           SMALL                      MED                        LG                          XLG

REGISTRATION STARTS : 6:00 PM,  Event Start 7:00PM

REGISTRATION FEE:      $20.00

Checks payable to:  Blood Sweat & Gears (BSGBC)

RELEASE TO ORGANIZERS & SPONSORS:

In signing this form for myself (or for the above name participant, if under 18 years of age), I understand agree to absolve all sponsors and organizers, be they individuals or organizers, singly and collectively, of all blame for injury, misadventure, harm, loss or inconvenience suffered as a result of taking part in the Fitness Five 5K event or any activities associated with the event. I further understand that, as an individual, I am responsible to abide by all traffic laws and regulations governing traffic and pedestrians, and take full responsibility for my actions.

Signature _______________________________________________________________________________________ Date ___________________________

Parent/Guardian Signature ( required if participate under 18)

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