JOIN US IN SUPPORTING MIDDLE SCHOOL ATHLETICS!
JOIN US IN SUPPORTING MIDDLE SCHOOL ATHLETICS! COURSE: The certified 5K loop will begin and end at Blakeney Shopping Center (at the corner of Ardrey Kell and Rea Road)
CORPORATE TEAM ENTRY FORM
REGISTRATION: Register at www.bigsouth5k.com or mail in this form to the Big South Conference office (address below). Pre-Registered runners (by Oct. 11) are guaranteed an official race shirt.
TEAM NAME:
RACE INFO: Visit www.bigsouth5k.com or call us at 704-341-7990
CONTACT’S ADDRESS:
TEAM CONTACT:
CITY: FINISH LINE PARTY: After the race, join us for th food, beverages, prizes, vendors, and the 10 Annual Blakeney Boo! Bash. AWARDS:
STATE:
ZIP:
PRIMARY CONTACT’S PHONE: PRIMARY CONTACT’S EMAIL:
TOP 3 Overall (M/F) TOP 3 Masters (M/F) TOP 3 Age Group (15 divisions M/F) TOP 3 Community Team Awards
MIDDLE SCHOOL BENEFICIARY (if desired): TOTAL # OF PARTICIPANTS:
TOP 3 Corporate Teams
# of participants @
Rates $20 until 7/31
Total $
@
$25 from 8/1 – 10/16
$
@
$30 from 10/17 to Raceday
$
@
$20 “Phantom Runner”*
$
Grand Total Due $ *A phantom runner does not participate in the race, but does receive a shirt.
SEND REGISTRATION CHECK (PAYABLE TO BIG SOUTH CONFERENCE) TO: BIG SOUTH CONFERENCE, C/O FLETCHER JONES, 7233 PINEVILLE-MATTHEWS ROAD, SUITE 100, CHARLOTTE, NC 28226
2016 BIG SOUTH 5K ROAD RACE CORPORATE TEAM WAIVER AND SIGN-UP FORM EVERY PARTICIPANT MUST SIGN SEND COMPLETED FORM AND CHECK TO: BIG SOUTH CONFERENCE, C/O FLETCHER JONES, 7233 PINEVILLE-MATTHEWS ROAD, SUITE 100, CHARLOTTE, NC 28226 *MAKE CHECKS PAYABLE TO BIG SOUTH CONFERENCE*
BIG SOUTH PARTICIPANT WAIVER AND RELEASE: WAIVER AND RELEASE MUST BE READ AND SIGNED WITH ENTRY. IN CONSIDERATION OF ACCEPTANCE OF MY APPLICATION TO PARTICIPATE IN THE BIG SOUTH 5K ROAD RACE, I WAIVE AND RELEASE ALL CLAIMS FOR MYSELF, MY HEIRS AND ASSIGNS AGAINST THE BIG SOUTH CONFERENCE, INC., QUEEN CITY TIMING AND ALL SPONSORS, ALL OFFICERS, DIRECTORS, AND MEMBERS OF SAID ORGANIZATIONS, AND THEIR RESPECTIVE EMPLOYEES, AGENTS, VOLUNTEERS AND ANY OTHER INDIVIDUALS WHO ARE IN ANY WAY ASSOCIATED WITH THIS EVENT, FOR ANY DAMAGES, ILLNESS OR INJURY OF ANY KIND WHATSOEVER WHICH MAY RESULT FROM MY PARTICIPATION IN THE BIG SOUTH 5K ROAD RACE THIS WAIVER AND RELEASE EXTENDS TO ALL CLAIMS OF EVERY KIND WHATSOEVER, FORESEEN, AND UNFORESEEN, KNOWN AND UNKNOWN, TO THE FULLEST EXTENT PERMITTED BY LAW. BY ENTERING THIS EVENT, I AGREE TO ACCEPT THE RISKS AND TAKE FULL RESPONSIBILITY FOR MY OWN WELL-BEING. I AGREE THAT EVENT OFFICIALS ARE AUTHORIZED TO OBTAIN EMERGENCY TREATMENT FOR ME IN THE EVENT I AM INCAPACITATED. I GIVE PERMISSION FOR THE UNCOMPENSATED USE OF MY NAME AND PICTURE IN AN ACCOUNT, PUBLICATION, BROADCAST, OR TELECAST OF OR REGARDING THIS EVENT FOR ANY LEGITIMATE PURPOSE. I ALSO ACKNOWLEDGE THAT THE OFFICIAL RACE DIRECTOR RESERVES THE RIGHT TO POSTPONE OR CANCEL THE RACE, OR TO CHANGE THE DAY AND/OR TIME, WITHOUT REFUND OF ENTRY FEES. I CERTIFY THAT I HAVE READ THE FOREGOING AND ACCEPT ITS TERMS. Print Name
Sign Name
Email
Gender
Date of Birth
Approx. Mile Time
Shirt Size YM-XXL
IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT OF LEGAL GUARDIAN MUST SIGN THE WAIVER AND AGREE TO ITS TERMS.
CORPORATE TEAM ENTRY FORM
REGISTRATION: Register at www.bigsouth5k.com or mail in this form to the Big South Conference office (address below). Pre-Registered runners (by Oct. 11) are guaranteed an official race shirt.
TEAM NAME:
RACE INFO: Visit www.bigsouth5k.com or call us at 704-341-7990
CONTACT’S ADDRESS:
TEAM CONTACT:
CITY: FINISH LINE PARTY: After the race, join us for th food, beverages, prizes, vendors, and the 10 Annual Blakeney Boo! Bash. AWARDS:
STATE:
ZIP:
PRIMARY CONTACT’S PHONE: PRIMARY CONTACT’S EMAIL:
TOP 3 Overall (M/F) TOP 3 Masters (M/F) TOP 3 Age Group (15 divisions M/F) TOP 3 Community Team Awards
MIDDLE SCHOOL BENEFICIARY (if desired): TOTAL # OF PARTICIPANTS:
TOP 3 Corporate Teams
# of participants @
Rates $20 until 7/31
Total $
@
$25 from 8/1 – 10/16
$
@
$30 from 10/17 to Raceday
$
@
$20 “Phantom Runner”*
$
Grand Total Due $ *A phantom runner does not participate in the race, but does receive a shirt.
SEND REGISTRATION CHECK (PAYABLE TO BIG SOUTH CONFERENCE) TO: BIG SOUTH CONFERENCE, C/O FLETCHER JONES, 7233 PINEVILLE-MATTHEWS ROAD, SUITE 100, CHARLOTTE, NC 28226
2016 BIG SOUTH 5K ROAD RACE CORPORATE TEAM WAIVER AND SIGN-UP FORM EVERY PARTICIPANT MUST SIGN SEND COMPLETED FORM AND CHECK TO: BIG SOUTH CONFERENCE, C/O FLETCHER JONES, 7233 PINEVILLE-MATTHEWS ROAD, SUITE 100, CHARLOTTE, NC 28226 *MAKE CHECKS PAYABLE TO BIG SOUTH CONFERENCE*
BIG SOUTH PARTICIPANT WAIVER AND RELEASE: WAIVER AND RELEASE MUST BE READ AND SIGNED WITH ENTRY. IN CONSIDERATION OF ACCEPTANCE OF MY APPLICATION TO PARTICIPATE IN THE BIG SOUTH 5K ROAD RACE, I WAIVE AND RELEASE ALL CLAIMS FOR MYSELF, MY HEIRS AND ASSIGNS AGAINST THE BIG SOUTH CONFERENCE, INC., QUEEN CITY TIMING AND ALL SPONSORS, ALL OFFICERS, DIRECTORS, AND MEMBERS OF SAID ORGANIZATIONS, AND THEIR RESPECTIVE EMPLOYEES, AGENTS, VOLUNTEERS AND ANY OTHER INDIVIDUALS WHO ARE IN ANY WAY ASSOCIATED WITH THIS EVENT, FOR ANY DAMAGES, ILLNESS OR INJURY OF ANY KIND WHATSOEVER WHICH MAY RESULT FROM MY PARTICIPATION IN THE BIG SOUTH 5K ROAD RACE THIS WAIVER AND RELEASE EXTENDS TO ALL CLAIMS OF EVERY KIND WHATSOEVER, FORESEEN, AND UNFORESEEN, KNOWN AND UNKNOWN, TO THE FULLEST EXTENT PERMITTED BY LAW. BY ENTERING THIS EVENT, I AGREE TO ACCEPT THE RISKS AND TAKE FULL RESPONSIBILITY FOR MY OWN WELL-BEING. I AGREE THAT EVENT OFFICIALS ARE AUTHORIZED TO OBTAIN EMERGENCY TREATMENT FOR ME IN THE EVENT I AM INCAPACITATED. I GIVE PERMISSION FOR THE UNCOMPENSATED USE OF MY NAME AND PICTURE IN AN ACCOUNT, PUBLICATION, BROADCAST, OR TELECAST OF OR REGARDING THIS EVENT FOR ANY LEGITIMATE PURPOSE. I ALSO ACKNOWLEDGE THAT THE OFFICIAL RACE DIRECTOR RESERVES THE RIGHT TO POSTPONE OR CANCEL THE RACE, OR TO CHANGE THE DAY AND/OR TIME, WITHOUT REFUND OF ENTRY FEES. I CERTIFY THAT I HAVE READ THE FOREGOING AND ACCEPT ITS TERMS. Print Name
Sign Name
Gender
Date of Birth
Approx. Mile Time
Shirt Size YM-XXL
IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT OF LEGAL GUARDIAN MUST SIGN THE WAIVER AND AGREE TO ITS TERMS.
