28th Annual Smokey Bear Fun Run by M3wWABC3


									                                          Entry Form
                            32 Annual Smokey Bear Fun Run - July 4, 2012
                     Please read the following information carefully and completely.
                                 Call 575-354-2748 with any questions.

Entry Fees:   $20.00 Early Registration until July 1
              $25.00 Late Registration, July 2 & 3
Mail completed entry form and check or money order payable to:
       Smokey Bear’s Hometown Association, P.O. Box 223, Capitan NM, 88316 -- or --
Drop Off at Smokey Bear Historical Park at 118 W. Smokey Bear Blvd. Capitan, NM
       Open 9 AM to 5 PM Daily or bring to the registration table to the event.
Race Divisions:      2 Mile and 10K
Age Groups:          10 & Under, 11-14, 15-18, 19-29, 30-39, 40-49, 50-59, 60-69, 70 & Over
Race Day Check-In: 6:30AM to 7:15 AM Wednesday July 4, 2012
Start:               Race begins at 7:30 AM
Location:            Smokey Bear Historical Park (118 Smokey Bear Blvd)

Please type or print legibly
Name: ________________________________________________________________________________
Address: ______________________________________________________________________________
City: _______________________________________ State: ______________ Zip: __________________
Home Phone: _______________ Work/Cell Phone: _______________ E-Mail_______________________

__ Male __ Female         ù Age as of July 4th 2012 ____          ù __ 10K Run         __ 2-Mile Run

Entry fee received by July 1 includes a T-shirt
(Check One Adult Size): ____ S ____ M ____ L ____ XL ____ XX ____XXX
Payments received after July 1 DO NOT qualify for a T-shirt. There must be time for T-Shirt printing to be
done before the day of the event.

                                           Save Time and Money!
Same-day registration is strongly discouraged. The lines may be long. Our volunteer staff has a tremendous
work load on race day. Please consider completing your registration, with payment, prior to the event.
Registrations and payments received July 2 or 3 DO NOT qualify for a T-shirt.

RELEASE OF LIABILITY – (Must be signed) Please read carefully before signing.
In consideration of your acceptance of this entry, by my signature below I intend to legally bind myself, my heirs,
executors and administrators, I waive and release any and all rights and claims for damages I may have against the
organizers of the 32nd Annual Smokey Bear Fun Run, for any and all injuries sustained and suffered by me during this
event. I also understand that in the event this race cannot be held as scheduled due to an act of nature or circumstance
beyond the organizers’ control, my entry fee is non-refundable. IN CASE OF INJURY OR INABILITY TO FINISH THE
NEAREST AID STATION OR MEDICAL FACILITY. Further, I hereby grant full permission to use any photographs,
videotapes, motion pictures, recordings, or any other record of this event for any legitimate purpose. I understand that the
entry fee is NON-REFUNDABLE, and that race numbers are non-transferable. I have read the above and understand that
by signing below I am releasing the organizers as stated above.

Signature of Entrant __________________________________ Date ________

Signature of Parent or Guardian __________________________ Date ________ (If entrant is under the age of 18)
How did you hear about the event? Email - Event Calendar Website – Posters/Flyer - Newsprint - Radio - Other _________________

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