---- --- --- --- Complete parts 1 - 6 Detach and Mail by June 4, 2008 --- --- --- --- -- -- -- -- -- -- -- -
Form Downloaded from FastRunningBlog.Com
1.
Name : _____________________________ Address: ______________________________________
City: _________________________ State: _____ Zip _________ Phone: ________________________
2. Gender Check one: ____Female _____Male Clydesdale ?____________________
3. Age on 6/14/08 __________
4. Race Category: Check one:
___ 5K $20 by June 4, $25 after $________ 5. T-Shirt Size Check one:
Adult _____XS _______S ______M
___ Kids Fun Run (7 & under and 8-12) $________ _____L _______XL
$10 by June 4, $15 after Youth _____S _______M
Make checks payable to: Heart of Holladay: $________ _____L (Youth shirts are cotton)
In consideration of this entry, I, for myself, my heirs, my executors, and administrators, waive any and all rights and claims I may have against the sponsors, coordination group, and any individuals associated with the event, or their connection with said event. I represent that I am in proper physical condition to participate in this race. By signing this form, I acknowledge that I have read and fully understand my own liability and do accept the restrictions.
6. Signature______________________________ Date_______________________
Running for St. George hopeful_________________________
(Photocopy form as needed for each participant)