Merrill King's Fit 4 Fall 5K & Fun Run
August 14, 2010
Roswell, GA

OFFICIAL ENTRY FORM – PLEASE PRINT

First Name: _________________________________ Last Name_____________________________________

Street Address: ___________________________________________________________________________  

City, State, Zip: ___________________________________________________________________________

Daytime Phone: ____________________  Email: __________________________     Age: ______    Sex: ______

T-shirt size (circle one):     S        M        L        XL        XXL                Fee Enclosed: $_______ 

____ Phantom Runner: I am unable to participate, but I would like to support the Rally! Foundation with my enclosed tax-deductible contribution.

Cost: T-shirts guaranteed to pre-registered runners on race day.
5K: $20 by 8/09/10. Late and race day registration will be $25.
Mile Fun RUn: $15 anytime

Waiver: In consideration of the acceptance of this entry to the Merrill King Fit 4 Fall 5K & Fun Run, I waive any and all claims for myself and my heirs and assigns on the officials and sponsors of the race any injury or illness which may result from participation. I realize this is a physical event which requires proper physical health. In the event of severe weather conditions, the race will be cancelled and your entry fee will be considered a donation.

Signature of Participant ________________________________________________ Date _______

Signature of Parent/Guardian ____________________________________________ Date ________
(if participant is under 18)

Please make all checks payable to
Rally! Care of Merrill King 5k

Please return completed registration form to:
Merrill King 5k
5775 Glenridge Drive Building C, Suite 120
Atlanta, GA 30328