2010 MULE KICK
"The Long Ear Gallop"
Saturday, April 3, 2010
Registration Form
COST
Preregistration (postmark by March 28 or
personal delivery to Columbia YMCA thru April 2, 8:00 PM.)
| |
5K |
$20 |
| |
1 Mile Family Trot |
$8 |
Race Day
| |
5K |
$27 |
| |
1 Mile Family Trot |
$12 |
Each race participant receives an official race T-shirt.
CHECK ONE EVENT
| 5K __________ |
5K Baby Jogger
Division ________ |
1 Mile Family Trot
________ |
The Baby Jogger division is one group for awards/results without
regard to sex or age.PARTICIPANTS INFORMATION
| Name _________________________________________ |
Gender _________
|
Address
_______________________________________
|
|
City, State, Zip
__________________________________
|
Mail to:
YMCA - Mule Day Kick
1446 Oak Springs Dr.
Columbia, TN 38401 |
Phone (______)
_________________________________
|
Age on Race Day
________________________________
|
Date of Birth
____________________________________
|
|
Shirt Size _____________ (S, M, L, XL, 2XL)
|
|
Entry Fee Enclosed
$______________________________
(make check payable to YMCA - Mule Day Kick) |
|
PARTICIPANT'S RELEASE
In consideration of your acceptance of my entry into this race, I, for
myself, my executors, administrators, and assigns, do hereby release and
discharge YMCA of Maury County, City of Columbia Parks and
Recreation Department, race organizers, volunteers, Nashville Striders, and all sponsoring businesses and organizations for
all claims of damages, demands, actions, and causes of actions whatsoever,
in any manner arising or growing our of my participation in this event.
I also hereby consent to allow emergency treatment in the event of injury or
illness. I hereby authorize the Mule Day Kick organizers to reproduce
any photographs, video and audio taken during race activities for
advertising and publicity purposes. I agree to pay $30 to the race
director in the event that I do not return the timing chip after the race. Signature of participant or Guardian if under age 18.
| _______________________________________________ |
____________ |
| Participant/Guardian |
Date |
|