2011 Monte Sano 10K and 5K Entry
Form Page
Incomplete or illegible applications may not be accepted. See you on race
day. Good luck.
ALABAMA RRCA 10K STATE CHAMPIONSHIP
Name: (first)_________________________(last)_____________________________
Male p
Female p
Address:
Telephone:____________________ Age on
Race Day:________ Birthdate:
mm/_____dd/_____yy/______
Select T-Shirt Size (adult
sizes): Sp
Mp
Lp
XLp
XXLp
OR
Select Tank Top Size (adult sizes): Sp Mp
Lp XLp XXLp
Fees: $10 for 10K or 5K
through Aug. 27, $20 after. $15 for both races through Aug. 27.
Select Race Distance: 10K p 5K p Both 10K & 5K p 1 Mile Fun Run p
Race Waiver: I, individually, (and/or as parent,
and/or guardian of the named minor) for and in consideration of acceptance of
this entry in the aforementioned event, do hereby release, remise, waive, and
forever discharge the Road Runners Club of America, the Huntsville Track Club
and any and all other supporting groups of this said racing event, together
with all their officers, agents, officials and employees, from any and all
liability, claims, demands, actions, or causes of action whatsoever arising out
of, or relating to any injury, illness, loss, or damage, including death,
relating to participation in the aforesaid event. I further state I am in proper physical
condition to participate in this event. In addition, I agree that my
participation in this event requires that I will not participate with roller
blades, baby joggers, skateboards, animals, headphones, or anything which the
race director deems dangerous to myself or other
participants and that the race director may remove me from this event for a
violation of said policy. I further
grant permission to this race and the organization conducting the race and/or
agents authorized by them to use any photographs, videotapes, motion picture,
recordings and any other record of this event for any purpose. I also that all entry fees are non-refundable
and this entry is non-transferable.
Signature:________________________________________________________ Date:______________
Parent/Guardian if under age 19
---------------------------------------------------------------------------------------------------cut
here----------------------------------------------------------------------------------------------
Mail application to:
Beth Benefield
Make checks payable to the Huntsville Track
Club.