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Race Registration Form |
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(please circle): Civilian/Military |
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Sex:_____M _____F |
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Shirt Size (please circle): LG/XLG |
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In consideration of my application being accepted, I hereby for myself, my heirs and executors, waive, release, forever discharge any and all rights and claims for damages which I may hereafter accrue to me against the organizers and sponsors of the Jim Thorpe 5K Run, as well as the Community Recreation Branch, Carlisle Barracks and the Department for the Army. I attest and verify that I am physically fit and have trained for the completion of this race. Further, I hereby grant full permission to any and all of the foregoing to use my name, photographs, or any other record of this event for any legitimate purpose, without compensation or remuneration. |
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Signature of Applicant:____________________________________________ |
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Date:__________________________ |
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Staff Member:______________________________________________ |
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Date:__________________________ |
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Participants Racing Number (This number will be assigned by a staff member upon processing. Please leave blank):________________________ |
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(Make checks payable to IMWRF. Mail to: HQ Carlisle Barracks, Attn: Sports, Bldg #120, Carlisle PA 17013) For more informatin phone (717) |
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Name: Last______________________________, First______________________________, MI_______ |
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Street Address:_______________________________________________________________________ |
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City:___________________________ State:______ Zip:_______________ |
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Race Registration
