Avery Tracks 10 Mile Run Lees-McRae College to Avery County High School • May 8, 2010 • 8:00am start
FIRST NAME
LAST NAME
ADDRESS
CITY/STATE/ZIP
GENDER (CIRCLE ONE)
MALE
FEMALE
DATE OF BIRTH
DD/MM/YYYY
AGE
TEE SHIRT SIZE (CIRCLE ONE)
SMALL
MEDIUM
LARGE
EXTRA LARGE
EMAIL ADDRESS
REGISTRATION FEE: $25.00 if postmarked by April 24, 2010. Avery Athletes: $10.00. $30.00 if postmarked after April 24, 2010 and on race day. PLEASE MAKE CHECKS PAYABLE TO: Avery County Athletic Boosters and MAIL TO: Avery County Athletic Boosters, PO Box 1656, Newland, NC 28657
WAIVER OF LIABILITY: I fully assume and understand the risks of participating in this event (road race) including death or injury due to vehicles, falls, collisions with other participants or spectators, actions by hostile humans or animals, uneven pavement, obstructions, adverse weather, sudden illness and all other risks. I attest that I am physically fit to participate. I authorize event officials to provide medical attention if at any time I should appear in need. For injuries I sustain, including death, I agree to save and hold harmless the Avery County Athletic Boosters, Avery County High School, Lees-McRae College, Lees-McRae Track, Lee Timing LLC, local government, law enforcement personnel, volunteers, event staff, race suppliers, race contractors and subcontractors, and any one else connected with the organization of this event, from any claim or lawsuit that may be brought at any time by me, my family, estate, heirs, or assigns arising from my participation in this event or the instruction I receive.
I give permission for free use of my name and picture in any broadcast, telecast or written account of this event. I understand that the entry fee is non-refundable.
SIGNATURE
DATE
SIGNATURE
DATE
SIGNATURE OF PARENT OR GUARDIAN IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE
COMPLETE, PRINT, SIGN, AND RETURN YOUR ENTRY FORM AND PAYMENT TO THE ADDRESS SHOWN AT THE TOP OF THIS PAGE