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ENTRY FORM |
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Name:____________________________________________________________________
Address: __________________________________ City: ___________________________
State: _________________ Zip: ___________ Phone: ( ) _________________________
Age: _____ [ ] M or [ ] F
Event: (check the appropriate box)[ ] 5K Run [ ] 5K Wheelchair [ ] 1 mi Family Walk T-Shirt Size: [ ] Small [ ] Med. [ ] Large [ ] XL [ ] XXL [ ] XXXL
WAIVER : In consideration of this entry, I hereby for myself, my executors, administrators and assignees waive any and all right of claims for damages I may have against General Mills , all sponsors and individuals associated with said event for any and all injuries sustained by me in this event. Also, none of the above are responsible for the loss of personal items nor any other form of aggravation in connection with the said event. I attest and verify that I am physically fit and have trained for this event. In filling out this form, I acknowledge I have read and fully understand my rights. Participant: If minor, parent or guardian must sign.
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Make checks payable to: General Mills ATTN: Gail Flynn P.O.Box 129 Murfreesboro, Tn. 37133-0129
To receive early registration fee rates your mail must be postmarked by May 30, 2008
All Profits go to the Local Charities No refunds no exceptions
Registration Fees 5k Run & 5k Wheelchair $25_____ Late Reg. 5k Run & $30_____ Wheelchair (After May 30. 2008) 1 mile Fun Walk $10_____ Late Reg. 1 mile Fun Walk (After May 30. 2008) $12_____
TOTAL ENCLOSED _________ |
