Dr. James H. Crowdis Run Entry Form
Name_____________________________________________________________ Age_____Date of Birth___________________
Address__________________________________________________________________________________________________
Street City/State/Zip
Email Address______________________________________________________Telephone______________________________
shirt size (circle one): XSmall Small Medium Large XLarge XXLarge
______ Male ______ Female ______ Runner ______ Walker _______5K _______ 1K
Registration fee by February 1: $25 ($30 on race day)
Waiver
In consideration of this entry I acknowledge that I am prepared for, and understand and assume all the risks associated with participating in this event and release the organizers and volunteers of the Dr. James H. Crowdis Run from all claims and liabilities resulting from my participation. I also grant permission to use my name, photographs and video images in the recording of and promotion of this event.
__________________________________________________________________________________________
Signature (parent signature if under 18) Date
Mail to: Dr. Crowdis Run Checks payable to: Dr. Crowdis Run
185 Fort Gaines Street
Blakely, GA 39823
Name_____________________________________________________________ Age_____Date of Birth___________________
Address__________________________________________________________________________________________________
Street City/State/Zip
Email Address______________________________________________________Telephone______________________________
shirt size (circle one): XSmall Small Medium Large XLarge XXLarge
______ Male ______ Female ______ Runner ______ Walker _______5K _______ 1K
Registration fee by February 1: $25 ($30 on race day)
Waiver
In consideration of this entry I acknowledge that I am prepared for, and understand and assume all the risks associated with participating in this event and release the organizers and volunteers of the Dr. James H. Crowdis Run from all claims and liabilities resulting from my participation. I also grant permission to use my name, photographs and video images in the recording of and promotion of this event.
__________________________________________________________________________________________
Signature (parent signature if under 18) Date
Mail to: Dr. Crowdis Run Checks payable to: Dr. Crowdis Run
185 Fort Gaines Street
Blakely, GA 39823