NAME:______________________________________________________________
ADDRESS:__________________________________________________________
CITY, STATE, ZIP:____________________________________________________
PHONE:______________________ T-SHIRT SIZE (circle one): S M L XL
DATE OF BIRTH:___________ AGE (on 2/16/08):_____ SEX (circle one): M F
E-MAIL:____________________________________________________________
WAIVER: In consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the City of Jacksonville, the Alabama Striders, all sponsors, volunteers and supporters of this race, with their representatives and successors from all claims or liabilities arising out of my participation in this event. I grant permission to everyone to use any photographs or records of this event for media use or any other legitimate purpose, without compensation to me.
____________________________________________________________________ Fee for runners 19-over is $12 early or $14 race day.
SIGNATURE (Parent or Guardian if under 18 years old) DATE
For Anniston Runners Club members, 19-over fee is $10 earlyor $12 race day.
Fee for runners 18-under is $10 earlyor $12 race day.
For Anniston Runners Club members, 18-under fee is $8 early or $10 race day.
Make check payable to Alabama Striders. Mail to:
Germania Springs 4 Mile; 110 Ladiga Street SE; Jacksonville, AL 36265
-----------------------------------------------------------------------------------------------Clip and mail