Official Hurricane Half Marathon and 5K
Registration Form
April 20, 2002
Race # __________________________________________________
Name: __________________________________________________
Age:__________ Sex: __________
Address: _______________________________________________
City: ____________________ State: ______ Zip: ______________
Phone# ________________________________
(Select One): 5K____ Half
Marathon_____
Male____
Female_____
(Circle Shirt Size): S M
L XL
2XL (add \\$1.00 more for 2XL)
Male Division
(Circle One) |
Female Division
(Circle One) |
11 & under
15 -18
25 - 29
35 - 39
45 - 49
55 - 59
65 - 69 |
12 - 14
19 - 24
30 - 34
40 - 44
50 - 54
60 - 64
70 + |
11 & under
15 -18
25 - 29
35 - 39
45 - 49
55 - 59
65 - 69 |
12 - 14
19 - 24
30 - 34
40 - 44
50 - 54
60 - 64
70 + |
|
WAIVER: In consideration
of your accepting my entry, I hereby-my heirs, executors and
administrators - waive and release all rights and clami for damages
I may have against The Hurricane Half Marathon and 5K run
at Virgin, LaVerkin, Hurricane cities, Washington county, or
the State of Utah, their representatives and assigns, for any
injuries suffered by me both while traveling to or from and competing
in said events. I further attest and certify that I am Physically
fit and have sufficiently trained for competition in this event
and my physical condition has been verified by a licensed medical
doctor (except where the latter is in a violation of religious
principles). |
|
Signature:_________________________ |
Date:_____________ |
_________________________________
Parent or Guardian (if entrant is under 18) |
Amount Paid:___________ |
|
