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WAIVER: In consideration
of your acceptance of this entry, I hereby release the sponsors/
organizers of this event from any damages, liability or injuries
suffered by me as a result of my participation in this event.
I attest and verify that I have full knowledge of the risks
involved and I am physically fit and sufficiently trained to
participate. I also give
permission for the free use of my name and picture in any broadcast,
telecast, or print media account of this event.
Only one participant per entry form, please.
You may use photocopies.
Make Check Payable to: CHS Fieldhouse Fund.
Name:
___________________________________
Phone:
______________________________________
Address___________________________________
___________________________________
Signature:
____________________________________
Please Circle:
Male
Female
Age Division:
19 & Under
20-29
30-39
40-49
50+
T-Shirt Size:
S -
M -
L -
XL -
XXL
Event:
Mile
Walk 5K Walk
5K Run 10K
Walk 10K Run
10K Bike
Signature of Parent/Guardian
______________________________
Are you a Thrivent Member _____ yes
_____no
NOTE: All
entrants under 18 must have the entry form signed by a parent
Mail form
and entry fee to: Robin
Hartley / |