49 Miles
North
Of
Lexington
KY

32 Miles
South
Of
Cincinnati
Ohio

5 Kilometer * Half-Marathon * Mile Fun Run * Falmouth, KY * Saturday, June 14, 2008    8:00AM

Home Information Entry Form Records Results Letter

Daniel Boone's Entry Blank
or
 Click to Enter Online

Mail entry form to: Craig Chaplin "Daniel Boone Run For Statehood"
309 Mary Ingles Hwy, Melbourne, KY 41059

 
NAME
                                    FIRST                   MI                                           LAST
BIRTHDATE --      PHONE
                              (MO)   (DAY)  (YR)  AGE RACE DAY
ADDRESS
CITY STATE ZIP
Put # of T-Shirts Ordered in Boxes
                                                       S M L XL
SEX MALE   FEMALE          HALF-MARATHON   5-K
Total Enclosed (Entry Fee Plus T-Shirt Order)    $ ______
WAIVER: In consideration of the acceptance of my entry , I hereby waive on behalf of my heirs, executors and assigns, all claims of any nature arising from my participation in the 2008 Daniel Boone's Run For Statehood, and do hereby release the Pendleton Pacesetters and all sponsors, workers, officials and volunteers from any claims of damages, demands, actions whatsoever in any manner arising or growing out of my participating in this event. I agree to abide by all rules for participation, and acknowledge that the Race Committee may refuse or return my entry at its discretion. I understand the risks for such a run and have trained adequately in preparation. I HAVE NOTED ANY MEDICAL CONDITION on the reverse side this form.
SIGNATURE: Each entrant must complete the signature line to indicate that he or she has read the waiver/release and has trained for this race. Entrants under age 18 must also have their parents sign this form.
Signature: __________________________________
                        (Signature of runner)
Parent's signature: ________________________________
                                        (If runner is under 18)
Leave blank

Race Number		 In case of emergency contact:
NAME (print) _____________________________
Telephone
Copyright 2006 Daniel Boone Run