Entry Form

3nd Annual Band of Gold 5K Run/Walk - May 30, 2009

Race begins @ 8am: Registration begins @ 7am

***Please Complete All Information***

Make checks payable to: South Point Band Boosters 

Mail to: South Point Band 5K, PO Box 321, South Point, Ohio 45680.   

Due by May 16, to guarantee you receive a t-shirt.

Amount Enclosed: $___________    Prior to race day, Adults - $15, Students (up to age 18) - $10 If registering on day of race, Adults $20, students $15

T-Shirt size (adult): ____S  ____M  ____L  ____XL  ____XXL  Youth: ____S  ____M  ____L  ____XL

Name: ________________________________________________

Address:_______________________________________________

City:_____________________________  State:_____________  Zip Code: __________

Phone:______________________  E-mail:____________________________________

Sex: M____  F____

Age on Race Day ________

WAIVER: In consideration of the right granted to me to participate in the Run for Gold 5K Run on May 30, 2009, I hereby waive all claims and damages against the South Point Band Boosters and any other sponsors and organizers arising from my participation or any injury I might suffer in this event.  I attest that I am physically fit and prepared for this event.  I understand that rollerblades, bikes, skateboards, etc. are not allowed.  Runners must sign below.

Runner's Signature _________________________________________  Date: _____________

Parent/Guardian (for minors under age 18) ___________________________________  Date: _________