Pre-registration: (ends 3/5/21) |
Through 3/5: $40 Half Marathon & Virtual Half Marathon $25 2-Person Relay | | Regular | Registration: |
$50 Half Marathon & Virtual Half Marathon $30 2-Person Relay | |
Counts towards SFTC Long Distance Series | ||||
Make checks payable to: Union High Cross Country | ||||
Mail this form to: Union High Cross Country 2 Champions Avenue Big Stone Gap, VA 24219 |
Headphones are permitted on the course | Strollers are permitted on the course |
For more info contact Emil Schenck, eschenck@wisek12.org | Union Half Marathon Male & Female Awards: Overall (top 3) Masters (top 3) GrandMasters (top 3) Age Groups (top 3) 19 under, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70 over | 2-Person Relay Male & Female Awards: Age Groups (top 3) Male, Female, Coed |
LAST NAME__________________________________ FIRST NAME_________________________ M.I._______ |
SEX____ DATE OF BIRTH____/____/____ AGE ON RACEDAY_____ E-MAIL____________________________ |
ADDRESS___________________________________________________________________________ |
CITY________________________ STATE_________ ZIP___________ PHONE (_______)_______-___________ |
RACE DAY EMERGENCY CONTACT (NAME AND PHONE)_________________________________________ |
TEAM NAME____________________________ |
*** CIRCLE EVENT: Union Half Marathon | 2-Person Relay |
*** CIRCLE SHIRT SIZE: SM, MD, LG, XL, XXL |
IN CONSIDERATION FOR ACCEPTING MY ENTRY IN THIS RACE, I FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE FOREVER ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE ORGANIZERS AND SPONSORS OF THIS EVENT. I ALSO RELEASE THE ABOVE NAMED FOR ALL CLAIMS OF DAMAGE DEMANDS, AND ACTIONS IN ANY MANNER DUE TO ANY PERSONAL INJURIES, PROPERTY DAMAGE, OR DEATH SUSTAINED AS A RESULT OF MY TRAVELING TO AND FROM AND MY PARTICIPATION IN SAID RACE. I ATTEST AND VERIFY THAT I AM PHYSICALLY FIT AND HAVE SUFFICIENTLY TRAINED FOR THE COMPETITION OF THIS EVENT. IN FILLING OUT THIS FORM, I ACKNOWLEDGE I HAVE READ AND FULLY UNDERSTAND MY OWN LIABILITY AND ABILITY. |
SIGNATURE_____________________________ DATE_____/_____/_____ (Parent signature if under the age of 18) |