whitehouse community ymca 5k glow run - Tyler YMCA
WHITEHOUSE COMMUNITY YMCA 5K GLOW RUN Whitehouse Community YMCA 903-839-9622
Race Information Date Time Reg until 5/12 Race-Day Reg Location:
Saturday, May 14, 2016 Race Starts @ 9:00PM $20 Adults, $15 Youth 7:00-8:30pm @ *Whitehouse YMCA only* Whitehouse Community YMCA 301 Terry St. Whitehouse, TX 75791 9:30-10:30pm-Music, food, & refreshments Email [email protected]
After Party/Awards Race Director
Register online @ www.whitehouseymca.org
Race Day Registration: Race day Registration Adults: Race day registration Youth:
$25* $20*
*Fees are nonrefundable
Runner’s Name: ___________________________ Gender: ____ DOB: ___/___/___ Age (as of May 14): _____ Address: _____________________________________ City: ___________________
Zip: ______________
Parent/Guardian’s Name: ___________________________________ Parent/Guardian’s D.O.B.: ___/___/___ (If under 18)
Primary Phone: ________________________ Secondary Phone: ______________________ Email Address: _______________________________________
4/23/16 to ensure a shirt! Must register by 4/23/2016 to ensure you receive an event shirt.___________
Shirt Size (circle):
YS
Entry Group (circle):
YM
YL
9 & under
AS
10-12
AM
AL
13-15
AXL *Register by
16-18
19-29
30-39
40-49
50-59
60+
I hereby certify that I am in normal health and capable of safe participation in this event. I assume all risks and hazards incidental to the conduct of this event and for the transportation to and from the event. I hereby authorize the YMCA to obtain medical treatment for me in the event that an injury occurs. By my own signature and my own free will, I do hereby agree to indemnify and save harmless the YMCA of Tyler, the City of Whitehouse, any sponsors, promoters, persons or entries associated with this event from any and all claims or demands, costs or expenses arising out of injuries, damages or other losses, whether personal or property, sustained by me or any party to whom I am responsible. I also understand any photography or film of my participation may be used for marketing and promotional materials without compensation.
__________________________________________ Signature
___________________________________ Date
Race Information Date Time Reg until 5/12 Race-Day Reg Location:
Saturday, May 14, 2016 Race Starts @ 9:00PM $20 Adults, $15 Youth 7:00-8:30pm @ *Whitehouse YMCA only* Whitehouse Community YMCA 301 Terry St. Whitehouse, TX 75791 9:30-10:30pm-Music, food, & refreshments Email [email protected]
After Party/Awards Race Director
Register online @ www.whitehouseymca.org
Race Day Registration: Race day Registration Adults: Race day registration Youth:
$25* $20*
*Fees are nonrefundable
Runner’s Name: ___________________________ Gender: ____ DOB: ___/___/___ Age (as of May 14): _____ Address: _____________________________________ City: ___________________
Zip: ______________
Parent/Guardian’s Name: ___________________________________ Parent/Guardian’s D.O.B.: ___/___/___ (If under 18)
Primary Phone: ________________________ Secondary Phone: ______________________ Email Address: _______________________________________
4/23/16 to ensure a shirt! Must register by 4/23/2016 to ensure you receive an event shirt.___________
Shirt Size (circle):
YS
Entry Group (circle):
YM
YL
9 & under
AS
10-12
AM
AL
13-15
AXL *Register by
16-18
19-29
30-39
40-49
50-59
60+
I hereby certify that I am in normal health and capable of safe participation in this event. I assume all risks and hazards incidental to the conduct of this event and for the transportation to and from the event. I hereby authorize the YMCA to obtain medical treatment for me in the event that an injury occurs. By my own signature and my own free will, I do hereby agree to indemnify and save harmless the YMCA of Tyler, the City of Whitehouse, any sponsors, promoters, persons or entries associated with this event from any and all claims or demands, costs or expenses arising out of injuries, damages or other losses, whether personal or property, sustained by me or any party to whom I am responsible. I also understand any photography or film of my participation may be used for marketing and promotional materials without compensation.
__________________________________________ Signature
___________________________________ Date
