Print Registration
| 2011 10 Mile Road Race Entry Form Note changes: No shirt with late entries and no entries will be accepted after Wed. May 18th. To contact us about registrations: entries@10mileroadrace.org | ||
| Print and complete form. Return by 5:00 PM May 18th to: | ||
| Fresh Air Experience (mail or drop off available at this location) |
| |
| NAME: |  | |
| ADDRESS | | |
| POSTAL / ZIP CODE | | |
| PHONE NO. | | |
| EMAIL ADDRESS | | |
| SEX | | |
| BIRTHDATE | | |
| TEAM / CLUB NAME | | |
| AGE AS OF May 23 | | |
| FIREFIGHTER DIVISION | ||
| T-SHIRT SIZE | XS S M L XL (please circle size) | |
| NO SHIRT OPTION | ||
| FEES | ||
| ENTRY - WITH SHIRT | $35.00 (BY MAY 12th) | |
| ENTRY - NO SHIRT | $20.00 (BY MAY 12th) | |
| LATE ENTRY - NO SHIRT | $40.00 (MAY 13th - 18th) | |
| ATTENDING DINNER? | Y N (PLEASE CIRCLE ONE) | |
| DINNER GUESTS | # @ $10.00 each | |
| (Do NOT pay for runner's dinner) | ||
| TOTAL | | |
| * Cheque Payable to:TEN MILE ROAD RACE | ||
| In consideration of Thunder Bay Professional Firefighters Association, the City of Thunder Bay and members of the organizing committee and all other volunteers and sponsors accepting my entry, I hereby, for myself, my heirs, executors, administrators and assignees, waive and release Thunder Bay Professional Firefighters Association, the City of Thunder Bay and their members and employees and members of the organizing committee and all other race volunteers of all claims and responsibility for damages, injuries and loss of articles which I may sustain as a participant in the Ten Mile Road Race. I acknowledge and understand all risks associated with this event and attest to be sufficiently trained to participate. I have read and fully understand this release/waiver. | ||
|
| ||
| Signature: | | |
| Gaurdian Signature | | |
| (must be signed by parent or gaurdian if under 19) | ||
