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Jimmy Williams Memorial 5K Run Registration Form - PowerPoint PPT Presentation


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Jimmy Williams Memorial 5K Run Registration Form. Saturday, May 3, 2014 at 10am at Willow Metropark 22900 Huron River Drive, New Boston, MI 48164. Event Cost: Early Registration $25 – by April 5, 2014 Late Registration $30 – between April 6 and April 30, 2014 Day of Race $35.

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Jimmy Williams Memorial 5K Run

Registration Form

Saturday, May 3, 2014 at 10am

at Willow Metropark

22900 Huron River Drive, New Boston, MI 48164

  • Event Cost:
    • Early Registration $25 – by April 5, 2014
    • Late Registration $30 – between April 6 and April 30, 2014
    • Day of Race $35

Mail Entries to: Jimmy Williams Memorial Run

26070 Whispering Willows Drive

New Boston, MI 48164

Name: _________________________________________

Address: _______________________________________

City: _____________ State: _____ Zip Code: _________

Telephone: ______________ E-mail: ________________

Gender (M/F): ______ Age (on 5/3/14): ________

Select T-Shirt Size: Youth S M L XL

Adult S M L XL

In consideration of acceptance of my race entry, I, for myself, my executors, administrators, and assignees, do hereby release and discharge the Jimmy Williams Memorial Run/Scholarship, the City of New Boston, all sponsors, supporters, participants, and spectators for all claims of damages, demands, actions whatsoever in any manner arising from my participation in said event. I attest and verify that I have full knowledge of the risks involved in this athletic event, am physically fit to participate in this event, and have my physicians approval. Further, I hereby grant full permission to any of the aforementioned to use my photograph, videotape, film, motion picture, or record of my participation in this event.

Signature _____________________________________________________________

Parent Signature (if participant is under 18) _____________________________________