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Crivitz Wolverine 5k
Saturday, August 13, 2011 8:00 a.m.
OFFICIAL ENTRY FORM - PLEASE PRINT
Please Print All Requested Information:
Name________________________________________________________________
Address_______________________________________________________________
City___________________________ State __________ ZIP__________
Telephone_________________________ E-mail_________________________
Circle One: Adult t-shirt size: S M L XL XXL
Age ______ Sex ______
Non competitive event. There will be no awards this year and only those registered by July 31st are guaranteed a shirt. Children under 9 will not receive a free shirt. If available, shirts can be purchased on race day.
Cost: $ 15 by July 31st $ 20 After July 31st children 9 and under are FREE
Waiver: I know that running a road race is a potentially hazardous activity. I am in proper physical condition to compete in this run/walk and assume all risks associated with my participation including, but not limited to, falls, contact with other participants, and the effects of the weather including high heat and/or humidity, traffic, and the conditions of the road, all such risks being known and appreciated by me. In consideration of this entry, for myself and anyone entitled to act on my behalf, I waive and release all race officials, volunteers, sponsors, and any others associated with this event. Furthermore, I hereby grant the agents of this event permission to use photos or any other record of me in this event.
Signature ______________________________________________
Parent/Guardian if under 18 _________________________________
Make checks payable to Crivitz Wolverine 5K
Mail to: Missy Gruszynski Race Director W6332 Circle Drive Crivitz, WI 54114
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