Thursday, January 1, 2009

Time :

Ø 12K Run / Walk begins at 9:00 a.m. Race day registration 8:00-8:45 at Clyde.

Awards:

Ø Classic Handcrafted Trophies will be presented to the first 3 male and 3 female finishers in the usual age groups

Entry Fees:
Ø Registration fee: $20.00 all event categories. $17 to all Pine Belt Pacer members who pre-register (no discount on race day)

Tee Shirts:

Ø Tee-shirts are only guaranteed on race day to the first 100 persons registered.

Print entry form below and Mail Entries to:

Pine Belt Pacers Steam Whistle 12K Run
Attn: Tony Mozingo
PO Box 244,
Purvis MS 39475

STEAM WHISTLE 12K RUN/WALK

9:00 am Thursday, January 1, 2009 Clyde Depot

Registration

Name: _____________________________ Age on Race Day:_____ DOB:___/___/___

Address: ___________________________ Phone: (home) _______________________

City / State / Zip: _____________________________ (day time) ____________________

Sex (circle one) Male Female Tee-shirt size (circle one) M L XL

Event (check one): 12K Run 12K Walk Entry Fee:$20

Waiver for the Steam Whistle 12K Run/Walk

In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am
traveling to or from the event, during the event, or while I am on the premises of the event. I am also aware of and assume all risks associated with
participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the course. I,
for myself and heirs and executors, hereby waive, release and forever discharge the event organizers, sponsors, promoters, and each of their agents,
representatives, successors and assigns, and all other persons associated with the event, for all my liabilities, claims, actions, or damages that I may
have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims,
whether caused by negligence, the action on inaction of any of the above parties, or otherwise.

I understand that the entry fee is non-refundable and non-transferable. I hereby grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, web site images, recordings or any other record of this event.

Signature: __________________________ Date: ____/______/______

(Parent if under 18 years of age)

Make checks payable to the Pine Belt Pacers and send to :