9a.m Sunday November 21, 2010
One Hill of a Run 5k and 10k and The Infamous Double Grand Rapids, MI
http://www.onehillofarun.mysite.com/index_1.html
Union High School coachdroski@aim.com 616-260-2669
One Hill of a Run 5K & 10K Road Race...Sat. November 20th, 2010
5K RACE STARTS at 9a.m....10K STARTS at 10a.m.
coachdroski@aim.com
Complete and Mail In this Form with Check or Money Order payable to:
Old Farts Running Club, 2010 Woodrun, Lowell, Michigan, 49331

Print Name: __________________________________________

Address: _____________________________________________

City: ____________________State: _____________ Zip:_______

Email Address: ________________________________________

Phone #: ( )_____-_________

Date of Birth: ______________ Age on Race Day:_____ Gender:_________
CIRCLE THE RACE YOU PLAN TO RUN:
5K......Early registration by Nov.1st is $15.00...after Nov.1st/race day...$20.00
10K...Early registration by Nov.1st is $15.00.....after Nov.1st/race day...$20.00
The Double...both the 5K and 10K is $25.00 before Nov.1st...after Nov.1st/raceday...$30.00
T-SHIRT SIZE: SM___MED___LG___XL___
TOTAL AMOUNT ENCLOSED:_______________ check #=___________ money order=_____________
One Hill of a Run Race Waiver: WAIVER MUST BE SIGNED BELOW FOR ENTRY TO BE ACCEPTED. IN REGISTERING FOR THIS RACE OR RACES I STATE THAT I AM FULLY AWARE, UNDERSTAND, AND ASSUME THE RISK AND RESPONSIBILITY FOR PARTICIPATING IN THE RACE ON A COURSE WITH VEHICULAR TRAFFIC AND THAT I HAVE FULLY CONDITIONED MYSELF TO THE APPROPIATE LEVEL OF FITNESS. I ALSO WAIVE ALL CLAIMS AGAINST THE RACE DIRECTORS, HOST SITE, SPONSORS, THE CITY OF GRAND RAPIDS, ETC. I AM ALSO AWARE OF THE FACT THAT IF THE RACE GETS CANCELLED DUE TO WEATHER OR OTHER UNFORE SEEN REASONS THAT THE RACE ENTRY IS NON-REFUNDABLE.

SIGNATURE:___________________________________DATE:____________________________

PARENT or GUARDIAN MUST SIGN IF UNDER 18 YEARS OF AGE:

SIGN:__________________________________________DATE:____________________________