Bobby Baker, Race Director
The USATF 5K Race Walk Championship
and the USA Junior Championship
Entry Form

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Easy Print Version

First Name:
Last Name
Sex:
Age on 10/04/08 race day:
Birthdate (MM-DD-YY):
USATF Membership Number:
Street Address:
City:
State:
Zip:
Telephone:
Email Address:
T-shirt Size:

Please print out this form, sign it, and mail with check to:

Bank of Tennessee
P.O. Box 4980
Johnson City, TN 37602
Attention: Renee Kleineick
Race Walk Entry Fee: $25.00 per person
(The post-race lunch has been cancelled.)		 Amount Enclosed:  
  Make check payable to:
USATF 5K Race Walk Championship
I hereby waive all claims for myself, my heirs, and executors against the USATF 5K Race Walk Championship and the USA Junior Championship, its sponsors, agents, and employees for any claims and liabilities which may result from my participation. I assume all risks associated with participating in the USATF 5K Race Walk Championship and the USA Junior Championship, but not limited to, falls, contact with other participants, the effects of the weather and conditions of the course, all such risks being known and understood by me. I further state that I am physically able to compete in my registered event.

Signature and Date:
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