By Air, By Rail Area Festival 5K – July 19 at 7:00 a.m.
This event is sponsored by the Fortville Optimist Club and all proceeds will benefit the Fortville Optimist Club and its programs.
Race will begin and end at the Mt. Vernon High School Parking Lot (on 200W).
This is NOT a competitive event. Children, strollers and pets are welcome. All proceeds will benefit the Fortville Optimist Club.
Entry Form (Separate
entry form is needed for each family member regardless of age)
Name:___________________________________
Age on 7-19-2008:______
Male
Female
Street:_______________________________________________________________________
City:________________________________________State:_____________
Zip:___________
Day Phone:_________________________ Evening
Phone:___________________________
T-shirt (short
sleeve) Size:
Small Medium Large X-Large
Additional t-shirts available for $15
Fees:
Pre-registered before July 1,
2008 - $25.00*
After July 1, 2008 and Day of Event - 35.00*
Children 2 and under are free.
CHECKS
ARE PAYABLE TO: Fortville Optimist Club
Mail completed entry form and entry
fee, by July 15, to:
By Air By Rail Festival, c/o The
Fortville Optimist Club, P.O. Box 302, Fortville, IN 46040
Registration and ticket pick up: 6:00 a.m.—6:45 a.m.
Event begins 7:00 a.m.
EVENT
PARTICIPATION AGREEMENT:
In
consideration of the foregoing, I, for myself, my heirs, executors
and administrators, waive and release any and all
rights and
claims for damages I may have against any of the sponsors,
organizers, Town of Fortville, Town of McCordsville
and The
Fortville Optimist Club, for any and all claims of damages, demands
or loss actions whatsoever which may arise as a
result of my
participation in this event. I understand and acknowledge that
participating in this event may
expose me to dangers from both
known and anticipated risks. I attest and verify that I am physically
fit and have
sufficiently trained for the completion of this
event and my physical condition has been verified by a licensed
medical
doctor. Further, I grant full permission to any and all
of the foregoing to use my likeness for any legitimate purpose
whatsoever
Signature_______________________________________________
Date __________________
Parent’s or Guardian’s
Signature if under age 18__________________________________________
Date ______________
Incomplete/unsigned entries will not be
accepted. - Entry form can be copied.