Geddes Fur Traders
2011 Walk/Run
Saturday, August 13
Registration/Waiver Form
(one entrant per registration)
Last Name_________________________First Name___________________
Address___________________________City_______________State______
Phone_( _)______________E-mail____________________________
I am entering (select one) 5K Run _____ 5K Walk____1 Mile Fun Run/Walk_____
Sex: M_____ F_____ Shirt Size: (circle one) S M L XL XXL
Age Bracket on day of event
[ ] Under 18 [ ] 18 29 [ ] 30 39 [ ] 40 49 [ ] 50 59 [ ] 60+
Ø Cost of registration: $15 (up to day of walk/run)
Ø Registration on day of walk/run: $20
Ø If you do not pre-register, you may register on the day of the walk/run beginning at 7:30 am on Saturday, August 13. Registration table will be located near the starting line in the parking lot of St. Anns Catholic Church (303 5th Street, Geddes, SD). Cash or checks only, please.
Ø Walk/run to begin at 8am SHARP
Legal waiver: I hereby for myself, my heirs and executors, release any and all claims or right to make claims against all of the sponsors, organizers, employees and volunteers associated in any way with the Geddes Fur Traders. I recognize and assume the risk inherent in walking or running a road race, including but not limited to the risk of injury associated with strenuous physical exercise, the risk of walking or running in or near traffic, the risk of uncertain weather conditions and the risk of walking or running on roads. This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.
Signature_________________________________Date_____________________
Parent Signature (if under 18 years) _______________________________________
Please enclose $15 for pre-registration. Make checks payable to Geddes Fur Traders and send to: Vonda Schulte, 37381 282 St., Geddes, SD 57342
_____Not racing but would love a t-shirt! _____T-shirt Size
Enclose $15 and fill out name and address on this form and send to above address.
(no need to fill out waiver portion of form.)
Entry forms will be available at the Elevator and Co-op Station
