Registration Form _Please Print__1_ by hcj

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									                             NO SWEAT X-C 5K


                                                                                       Location : Mount Dora Golf Club
   Tuesday June 22nd, 2010                                                                        1100 S. Highland St
   Race starts – 6:45 PM                                                                          Mount Dora, FL

Course Details:
This is a 5K cross country race held on Mount Dora Golf Club’s challenging and rolling course. Grass, dirt
and trails make up a scenic run through and around the shady golf course.
Safety guidelines: This is a cross country race with uneven terrain, tree roots and hay bale jumps.
Insurance does not cover the following, therefore, they are not allowed: Headphones, i-pods, bicycles,
skateboards, rollerblades and animals. No strollers or baby joggers. Spikes allowed (up to 3/8”).
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Awards- First place overall- male & female & top three in the following age groups:
Age groups- 12 & under, 13-15, 16-18, 19-29, 30-39,40-49,50-59,60 &over
Entry Fee- S10.00 - No T-shirts-
Optional Spaghetti dinner w/ drink available for $10.00 (prepaid only)
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Registration Form (Please Print)

Name: _______ _________________________________                                Phone: ___________________________________
Address: _________________________________                          E-mail:
___________________________________
City/State/Zip Code: ________________________
_________________________________________
Age on Race Day:      _________________________                               Date of Birth:
_________________________
Sex:    □ Male       □ Female

Emergency contact: ________________________________________
Home Phone: _____________________________                           Alternate Phone Number:
____________________
Entry Fee:
Through June 19th           $10.00__________
June 20-race day             $15.00 __________                 Race & Spaghetti dinner $20.00 __________
Please make checks payable to:   On The Run Fitness
Credit Card- Visa- MC – Acct #___________________________________ Exp- __________
Name on account-_______________________________________________

On The Run Fitness
301 N Baker Street # 101
Mount Dora, Florida 32757
Fax #- 561-681-5390

WAIVER (MANDATORY)
I, the undersigned, hereby waive and release the City of Mount Dora, Mount Dora Golf Club, On The Run Fitness, all event sponsors,
employees and volunteers from any claims, damages, actions, liability, and expense in connection with loss of life, personal injury,
and/or damage of property which may occur as a result of running, walking, or engaging in any type of physical activity during the
event. I give my full permission to the event organizers to use any photographs and videotapes that are made during the event.

_______________________________________________________________

_______________________________________________________________
Signature of Participant or of Parent/Legal Guardian (If participant is under 18)                      Date_______________

								
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