5^th Annual Crivitz Wolverine Walk / Run

Hot Trot

 

Saturday, June 2^nd, 2012

8:00 a.m.

 

OFFICIAL ENTRY FORM – PLEASE PRINT

 

Name____________________________________________

 

Address __________________________________________

 

City_____________________ State______ Zip ___________

 

Telephone___________________ E-mail_________________

 

Circle One:   Adult t-shirt size:    S         M        L         XL      XXL

 

Cost:   $15.00 if registered by May 15th, and $20.00 after May 15th

           ^{Kids 9 and under are free, and can purchase a shirt if available}

For more information contact: Missy Gruszynski at 715-854-2426

 

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

                      W6332 Circle Dr.

                      Crivitz WI 54114