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Tom Walker Memorial 13.1 and 5k Paper Registration Form

July 08, 2017 12:52 PM | Betsy Suda (Administrator)

Tom Walker ½ Marathon & 5k 2017!

  

November 11, 2017 @ 8:00 a.m

Boulware Springs Nature Park, 3300 SE 15th Street, Gainesville, FL 32641

 

If mailing in entry please send this form to:

 Florida Track Club (Tom Walker Races)

c/o Betsy Suda

4190 NW 50th Drive, #7305

Gainesville, FL 32606

Mail in entry deadline: November 8th, 2017  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  oS   oM   oL   oXL

                                                                               (check one – tshirts are first come, first served)                 

Contact phone number  _____________________________________________ 

 

I am participating in the (check one):   oHalf-marathon o5k

 

FTC Member?  oYES                        oNO

 

Interested in joining the Florida Track Club ($30/year)? See the benefits at www.floridatrackclub.wildapricot.org

                                         

Half-marathon

Early registration (before 9/16/17) $35, (9/17-11/8) $40  (FTC members take $5 off) 

Race day: $45 everyone

 

5k

Early registration (before 9/16/17) $22, (9/17-11/8) $25 (FTC members take $5 off)

Race day: $30 everyone                

 

Total enclosed $  ____________ 

Kids under 13, $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 or guardian if Participant is under 18


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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