1858 CELEBRATE MULBERRY'S
SESQUICENTENNIAL 2008
MulberryFest FORTH Annual 5k Fun Run & Walk
7 June 2008
Release
and waiver statement (must be signed). I have read all information and understand
the description of the event. I know that running and or walking a road race can
be a potentially hazardous activity. I should not enter unless I am medically
able and properly trained. I agree to abide by any decision of a race official
relative to my voluntary participation in this event, including but not limited
to, falls, contact with other participants, effects of the weather, including
extreme cold, ice, snow, heat, traffic, and all conditions of the road, all such
risks to be known and appreciated by me. Knowing these facts, and in consideration
of your accepting my entry. I for myself, my heirs, executors, administrators,
or anyone else who might claim on my behalf, covenant not to sue and waive, release,
and discharge Mulberry Festival Committee, the Town of Mulberry, Madison Township,
Mulberry Volunteer Ambulance Service, Madison Township Fire Department, Clinton
County Sheriffs Department, Mulberry Police Department, any and all event sponsors,
race officials, workers and volunteers, their representatives, successors or assigns
for any and all claims or liability whether foreseen or unforeseen, for death,
personal injury or property damage arising out of , or in the course of my participation
in this event.
FIRST NAME ______________________MI
_____ LAST NAME ______________________________
SEX:
MALE ____ FEMALE ___
AGE ON JUNE 7th _________ D.O.B._____/_____/______
SHIRT SIZE _______________
ADDRESS: ______________________________________________________________
CITY ________________________________ STATE ______ ZIP ___________________
PHONE
NO. ______________________________ E-MAIL ____________________________________
EMERGENCY CONTACT:
NAME ________________________________________
PHONE NO. ___________________________
Please
submit registration form and check or money order for $15.00 to
MulberryFest
2008
P.O. Box 426
Mulberry, In 46058
Payment must be received on
or before 28 May 2008.
Prizes will be given for
men's and women's 1st place, boys and girls 14 and under, and men's and women's
45
and older. A raffle will be held after the race with prizes from many
local businesses.
Signature of participant: ___________________________________________________
Signature
of parent or guardian (needed if participant is under 18 years of age): _____________________________
Registration
starts at 6:15am at Trinity Church of Christ on Hwy 38 and Main St. and race starts
at 7:00am.
Race starts in front of the church and ends at Mulberry United
Methodist Church.
START Main St.
FINISH Perrin
St.
