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MAIL TO: Northwood FF Memorial Run, 2100 Tracy Rd, Northwood Oh 43619
EMAIL TO: [email protected]
I will be participating in: 5K ( ) 1 Mile Walk ( )
Age Group: _ 17 & under _18 – 29 _ 30 – 39
_ 40 – 49 _ 50 – 59 _ 60 & over
Medals to top male/female overall, youngest/oldest and top 3 all age groups
Registration Fee: $10.00 before June 18, 2012 - $15.00 after June 18, 2012
WAIVER STATEMENT: (entry invalid if not signed) I assume full and complete responsibility for any injury or accident which may occur to me during the race or while I am on the premises of the event, and I hereby release and hold harmless the Northwood Fire Fighters Association, City of Northwood, the sponsors, promoters and all other persons and entities associated with the event or their agents or employees or otherwise. I further certify that I am in good physical condition and fully able to participate in this event. I understand that fees are not refundable and that bikes, skateboards, skates or glass are not allowed. ______________________________________________________ Entrant’s signature (if under 18, signature of legal guardian required)
