5 Mile Race starts
at 9:00
DEADLINE FOR MAIL IN REGISTRATION: MUST BE RECEIVED BY AUGUST 4th, AFTER THAT PLEASE BRING THIS APPLICATION RACE MORNING FOR SAME DAY REGISTRATION.
Name: Age: _____ M/F ___
Email: ______________________________________ (used for confirmation of registration, etc)
Phone:
1
Mile Run (13 & under) ______ 5Mile Race
Street
Address:
State:
Zip:
Emergency Contact: _________________________ Phone #:____________________________
1 Mile Kids: T-
Shirt Size (Free to the first 50 registrants):
Entry
Fees: $25 for the 5 Mile race, after Jul 23 $35
$12 for the 1 Mile Kids run, after Jul 23 $15
Entries are being capped at 250 for the 5 Mile Race. Please check our website for the current number entered. The race will very likely be capped out before race day.
Registration booth will be open at 7:15AM to 8:30AM. All runners must register that morning and pick up their race number. Children must have a parent sign.
(1
Mile Kids Run: if your child is not officially entered by Jul 23rd,
please let us know via email by Jul 23rd to ensure we have a t-shirt if we have not yet reached 50 registrants. pkaraz@gmail.com
)
Please
make checks payable to Bolder Inspiration and send to:
Bolder
Inspiration
c/o
Karaz
6186
Military Rd.
Remsen,
NY 13438
I know that running a road race is potentially a hazardous activity and that I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of the race official relative to my ability to safely complete the run. I assume all the risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat, humidity, lightning, high winds, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Bolder Inspiration race and its officials, USATF, event volunteers, the Town of Russia, sponsors, landowners where the event is being held, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Entry fee will not be returned due to “acts of God”. Further, I grant permission to all the foregoing to use my name and images of myself in any photographs, motion pictures, results, publications or any other print, video graphic or electronic recording of this event for legitimate purposes.
Signature:__________________________________________________ Date: ________
Parent’s Signature (if under 18) _________________________________ Date:________