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Name_____________________________ Social Security Number_________________
Mailing Address_____________________________________________________
City________________ State_________ Zip_________ Phone(____)___________
E-Mail: _________________________
Age on Race Day: ________
Gender (circle one): M F
Birthday: ________________________
Shirt Size(circle one): M L XL NOSHIRT
Entry(circle one): Walk Run
Entry fee: $20 ($12 w/out t-shirt) before June 30th
Entry fee: $22 ($14 w/out t-shirt) after June 30th
Entry deadline: Friday, July 2nd 2010
Waiver of Legal Liability
By signing below, I do hereby release and discharge from liability the Village of Fisher, The Fisher Fair, Champaign County, the directors, organizers, sponsors, supervisors, volunteers of the Fisher Fair 5K and their representatives, successors and assigns for any and all injuries suffered by me in this event, however incurred or sustained. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event. Further, I hereby grant full permission to any and all of the foregoing to sue my photograph, video, recording or any other record of this event for any purpose whatsoever.
________________________________________________________
Signature of Runner/Walker (Guardian if under 18)
Mail 5K entry fee and form to Fisher Fair 5K, David Peters, 605 S Fifth St., Fisher, IL 61843
All American Mutt Show
Entry Form
Name_____________________________ Social Security Number_________________
Mailing Address_____________________________________________________
City________________ State_________ Zip_________ Phone(____)___________
All-American Mutt Show
Name of dog________________________
Classes: (Limit 2) _____________
______________
Bring Registration form with you :
When - July 11 Registration 9am
Where - Livestock Barns
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