Waiver for the Hobble then Gobble 5 mile Run and 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 road. 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: Pine Belt Pacers
Mail Entries to: Pine Belt Pacers, Attn: Dawn Smith, 353 Emerson Dr., Hattiesburg, MS 39401
(Parent if under 18 years of age) Make checks payable to: Pine Belt Pacers
Mail Entries to: Pine Belt Pacers, Attn: Dawn Smith, 353 Emerson Dr., Hattiesburg, MS 39401
Name: _____________________________ Age on Race Day:_____ DOB:___/___/___
Address: ___________________________ Phone: (home)
______________________
City / State / Zip:
_____________________________
(day time) ____________________
Sex (circle one) Male Female Tee-shirt size (circle one) S
M L XL
Event (check one): ___5M
Run ___5M Walk email
address:______________________
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Registration
Hobble then Gobble 5
Mile Run and Walk
Hobble then Gobble 5 Mile
Run and Walk
Entry
Fees:
ØPre-registration
postmarked by November 18, 2006:
$18.00 all event categories
$15.00 PBP Club Members in
pre-registration
ØDay
of Race registration:
$20.00 all event categories (ex.,
Fun Run free)
$10.00 no Tee-shirt option
$45.00 Families over 3 people
ØAdditional information and on-line registration available on club web site:
www.pinebeltpacers.org
Registration:
ØMail completed registration before November 18, 2006; or
ØRegister race day at Lake Serene Club House beginning at 7:00 a. m.
Thursday, November 23, 2006
Lake Serene Club House
(Hwy 98 West to West Lake Serene entrance)
(Hwy 98 West to West Lake Serene entrance)
Time :
5 mile Run and Walk begins at 8:00 a.m.1 mile Fun Run begins at 9:00 a.m.
Course: A new course between the lakes.
Awards:
Ø5 mile Run awards of
turkeys will be presented to the Overall, Master & Grand Master
finishers in both males and female categories.
ØTrophies will be awarded
to top 3 Males and Females in 10 year age groups for the 5 mile run:
0 - 19 20 - 29 30 – 39
40 - 49 50 -
59 60-up
ØTop 3 Male and Female
Walkers will receive turkeys and next two places will receive trophies.
Tee Shirts:
Tee-shirts are only
guaranteed on race day to those registered before November 18, 2006.
Post-Event Activities:
Refreshments and award
ceremonies immediately after the event.
Benefiting children with Muscular Dystrophy