Registration Form
One person per entry, photocopies acceptable, Additional forms - www.watkinsmuseum.org
Address:
Date of Birth: _____________ Sex: ______ Daytime ph: _____________ Evening ph:_________
Runners: $15.00 Late Registration $20.00 T-shirt size: Please check one
Walkers.................$10.00 /Adult □ S □ M □ L □ XL □
XXL
Family ..... $25.00
- Run
Day Registration:
- Walk
begins at
- Entry Fees will be waived with $100.00 in sponsors.
- Free pancake
breakfast for runners & walkers after event (coupon will
be included in race packet)
SPONSOR: $________________TOTAL AMOUNT ENCLOSED: $_____________________
(Please make checks payable to
Release: In consideration of
your acceptance of this entry, I hereby, for myself, my heirs, my executors and
administrators, waive any and all rights and claims for damages I may have
against the sponsors, coordinators groups, and any individuals associated with
the event, the representatives, and successors for all injuries suffered by in
connection with said event. I have been warned I must be in good health to
participate in this event. In filling
out this form, I acknowledge that I am an amateur in such events. I also give permissions for the free use of
my name and picture in any broadcast, telecast, or printed media account of
this event. In filing this form, I
acknowledge I read and fully understand my own liability and do accept the
restrictions.
SIGNATURE__________________________________*DATE______________________
SIGNATURE OF PARENT OR GUARDIAN (if under 18) ___________________________
Sponsored by: WCMH, Sons of Union Veterans of the