Please print all information clearly and
complete all items on form. ast
Name:
F irst
Name:
Address:
City:
State:
Zip:
Email Address:
B irth Date
(MM/DD/YYYY):
SEX:
Event
(Check One):
1 Mile Run
10,000 Meters
AGE GROUPS and AWARDS
10K :
1 st,2nd, 3rd Male & Female
Overall Male/Female: 18 & Under,
19-29, 30-39, 40-49, 50-59, 60 & Over
1 Mile Fun Run
1st, 2nd & 3rd
10K Relay: st place male st place
female
T-Shirt Size:
L XL
* T-Shirts guaranteed to the first 75 participants. Entry Fee:
$25 –
10K
$15 - Mile Run
$50
10K Relay
$30 10K Late Entry
$20 –
Mile Run Late Entry
$60
10K Late Entry(Pre-Registration ends May 15, 2008 /Postmarked
May 14 th )
Make Checks Payable To:
White Lake Water Festival
Race Director
Waiver
below must be signed if application is to be accepted: In consideration of
the acceptance of this entry I hereby, for myself, executors,
administrators and assigns, release and discharge the White Lake
Water Festival, Elizabethtown-White Lake Chamber of Commerce,
Goldston’s Beach, al., and the North Carolina Association of the
Athletic Congress of the U.S.A.(NCA/TAC/USA), the promoters,
managers, agents, servants, employees, and the sponsors, whose
facilities are being used for this event, from any and all claims
for damages suffered by me as a result
of my participation in,
or traveling to or from the said event to be held May 18, 2007.
I specifically release
and discharge the said promoters and sponsors, listed above, whose
facilities are being used for this event, etc. from all injuries or
damages arising from or contributed to by any physical impairment or
defect I may have, whether latent or patent, and agree that they are
under no obligation to provide a physical examination or other
evidence of my fitness to participate in such event, the same being
my sole responsibility.
I also give permission
for the free use of my name and picture in any broadcast, telecast,
or other written account of the event. ________________________________________________________