Jay Cullen/Share the Road 5K
April 26, 2008, 8:30 a.m.
Cumming
OFFICIAL ENTRY FORM – PLEASE PRINT
Name: ________________________________________________ Age: ______ Male/Female: ______
Address: _________________________________________ City_________________ State______ Zip___________
Phone: ______________________________ Email: ____________________________________
T-shirt size (circle one): S M L XL
How did you hear about the race? ____ Newspaper ____ TV/Radio ____ Friend _____Church ______Online ______Other
| Cost: T-shirts guaranteed to pre-registered runners on race day. $15 by 4/13/08. Late and race day registration will be $20. |
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WAIVER: By submitting this entry form and participating in this event, I hereby assume myself, or my minr child, all risks of participating in this event. Further, I do agree to indemnify First Baptist Church, Cumming against any injury or claim which might result from any and all negligent acts or omissions of any persons(s) or entity. |
Signature of Participant ________________________________________________ Date _______
Signature of Parent/Guardian
____________________________________________ Date ________
(if participant is under 18)
Make Checks Payable to: First Baptist Church and mail to:
Jay Cullen Memorial 5K, 1597 Sawnee Drive, Cumming, GA 30040