Note: when printing, set document margins to .25”
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A Sierra Challenge Express
$1,000 Drawing Series Race 2009 July 4th Freedom Run/Walk Saturday, July 4th 4-Mile Run or Walk, Riverview Shelter, Print
this page – photocopies welcomed! Do
NOT email. Complete this entry form
and bring to Walk-in or Race Day Registration. |
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Paul Ronshausen, Race Director Questions? Email: pronshausen@hotmail.com ~ Telephone (559) 284-7421 |
Sorry, NO refunds and NO substitutions. PLEASE, print legibly. One entrant, one event per form. |
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NAME |
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First & Middle Initial:
________________________________________
Last:
________________________________________ |
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MAILING ADDRESS |
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(include box or apt. no.): __________________________________________________________________ |
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CITY, STATE: __________________________________________________________ Zip ____________ |
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E-MAIL: _______________________________________ |
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TELEPHONE: _________________________________ (circle one) Day Evening |
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4-Mile
EVENT (circle): Run Walk
(must walk entire course) AWARDS – RUN: First male &
female and top three (3) in age division; WALK: First three (3) male &
female – NO divisional awards |
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SOCK SIZE (circle one): S M L RUNNING SOCKS TO FIRST 200 ENTRANTS! |
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GENDER (circle one): Female Male AGE (on race
day): ______________ |
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AGE
DIVSION (circle): 14-un 15-19
20-29 30-39 40-49 50-59 60-69 70-ov |
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WAIVER: In consideration for being permitted to participate
in the 2009 July 4th Freedom Run/Walk, I, intending to be legally
bound and with full knowledge of the strenuous and potentially dangerous nature
of this event, do hereby for myself, my heirs, guardians, and legal representatives, assume all risk and
waive and release any rights to claims or damages I may incur against Sierra
Challenge Express Running Club, Leukemia and Lymphoma Society of America, Candlelighters and any members of the committee,
sponsors, race director, race officials, their agents, representatives,
successors or assignees for any and all injuries, damages or other
consequences suffered by me resulting from my participation in this event. I
also agree to the free use of my name and/or picture in any publication,
broadcast, telecast, or other account of this event and retain no rights
whatsoever to any photographic representation or to the publication or work
in which such representation may appear. I have carefully read and understand
the contents of this waiver. NO
refunds and NO substitutions. Signature of Entrant
_____________________________________________ Date:
______________ If under 18 years of
age, Signature
of Parent or Guardian |
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Pickup Socks & Race Number at Walk-in Registration or Race
Day Registration |
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Make
check or money order payable to: Sierra Challenge Express Event benefits Leukemia and Lymphoma Society, Candlelighters
& Sierra Challenge Express |
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Dropped off or mailed BEFORE June 16 $15.00 |
BEFORE June 16, drop off entries
at Sierra Running Company (address
below) or mail to: P. Ronshausen 3456 |
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June 16 to July 3 $20.00 Please,
do NOT mail after
June 30 |
Drop off entries & Walk-in
Registration – Thu
July 2 & Fri July 3, Sierra Running Company Telephone: (559) 433-6750 |
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Race Day $25.00 Socks, if
available |
Race Day Registration – Riverview Shelter, |