CJ Invitational Center Creek
5K Run
Mail In Registration Form
October 10th, 2009
Carl Junction Park, CJ, Mo.
A small convenience charge is added.
Simply print form and send completed form and payment, following the directions below. Each participant must have a completed form!
Name_______________________Ph #_____________
Email Address:_________________________________
(Please include! Any additional info will be sent to you thru email.)
City:_________________State:____Zip:_______
Age on day of race:______ Male:____Female:____
___$20 Pre-Register Fee - Make checks out to: CJ K-3 PTO
Please indicate shirt size: Kids: M L Adult: S M L XL
Register by September 25th to guarantee t-shirt on race day!
Waiver Must be signed before participating:I know that running is a potentially hazardous activity. I should not enter or run in this event unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this race including, but, not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreicated by me. Having read this waiver, knowing these facts and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the CJ Invitational Center Creek 5K Run, all sponsors, organizers and volunteers of this event, including the CJ School District and the City of Carl Junction, MO. All fees are non refundable. I also authorize use of my picture for any publication or media use.
Printed Name of Participant:________________________
Signature:_________________________Date:________
(guardian if under 18 years of age)
Please return completed form to:
any CJ K-3 office or CJHigh School office, indicate 5K Run
Or mail to: CJ K-3 PTO, 206 S. Roney, CJ, Mo. 64834