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Melon Run Paper Registration Form

May 28, 2015 7:16 PM | Betsy Suda (Administrator)

 

37TH MELON RUN JULY 4TH 2015!

 

 

 

July 4th:  3 mile @ 8:00 a.m., 1 mile Kids Fun Run @ 9:00 a.m.

 

If mailing in entry please send this form to:

 

Florida Track Club (Melon Run)

P.O. Box 12463, Gainesville, FL 32604.

Mail in entry deadline: June 30th  Day of registration will close @7:30 a.m.

 

Last Name  ___________________________________________ First Name  ___________________________________________________  

 

Gender (check one):   oM           oF                       Age (race day)  ______________________________________________ 

 

Address  ______________________________________________ City/State/Zip  _______________________________________________ 

 

E-mail Address ______________________________________ T-Shirt Size:                 Shirt Size  oS   oM   oL   oXL

                                                                                    (check one)                 

Contact phone number  _____________________________________________ 

 

I am participating in the (check one):   o3-Mile Melon Run                    o1-Mile Fun Run

 

FTC Member?  oYES                        oNO

 

Interested in joining the Florida Track Club ($20/year)? See the benefits at www.floridatrackclub.wildapricot.org

                                         

Early registration $25 ($20 FTC)               Race day $30 ($25 FTC)                

                                                                                                                                                                           Total enclosed $  ____________ 

Kids under 12, $5 (no shirt)                        

 

I know that running a road race is a potentially hazardous activity.  I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and understanding these facts, I, for myself and anyone acting on my behalf, waive, and release, the members of The Florida Track Club, and all other sponsors and their representatives from all claims and liabilities of any kind arising out of my participation of this event even though that liability might arise out of negligence or carelessness on the part of persons named in this waiver. I understand and agree to abide by the insurance restrictions, which prohibit the use of portable sound systems, wheel conveyances (excluding racing wheelchairs) but including skateboards, roller skates or blades, bicycles, etc. Illegible applications may result in disqualification. My entry in this race authorizes the Florida Track Club, organizations conducting races, or sponsors to record the race and its results in any medium and use those recordings in its discretion for any purpose. The Florida Track Club, organizers, or sponsors in no manner guarantee the accuracy of recording or reporting of results of any race.

 

_________________________________________                        _____________________________________

Signature of Participant                                                                            Signature of parent or guardian if Participant

                                                                                                          is under 18 years of age                                                        

 


The Florida Track Club is a member of the Road Runners Club Of America and the USA Track and Field Florida Association.


    

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