Fruit Hills 5K

Bristol Fruit Hills Classic
5k Run/Walk
Saturday July 9, 2011 @ 8:00 am
Registration @ 7:00 am

DISTANCE: 5k (3.1 MILES)

PLACE: Bristol American Legion Post 143 905 Maple Street Bristol, IN
FEE: $20 (includes t-shirt while supplies last)

QUESTIONS: Garycubfan@comcast.net or (574) 312-4687

REGISTRATION: Mail entry form to:

Bristol Fruit Hills Classic
c/o Gary Kruse
2616 Martin Manor Drive
Goshen, IN 46526

PLEASE USE ONLY ONE FORM PER REGISTERED PARTICIPANT (This form may be photo copied)

_____________________________________________________________________________________

Name: _______________________________________________________________________________

Address: ______________________________________________________________________________

City/State/Zip:_________________________________________________________________________

Age: ______________________________ Sex: _____________________________________________

T-SHIRT: S______ M ________ L _______ XL: _______

FEE $20 ______________
(checks payable to: Bristol Homecoming Festival)
 
Waiver: In consideration of the acceptance of this entry form, I waive myself and all my heirs and all their
claims for damages against the sponsors of the Bristol Fruit Hills Classic and its representatives and all
race officials and volunteers for injuries received during and as a result of this event. If I should suffer
injury or illness, I authorize officials at the event to use their discretion to have me treated and to be
transported to a medical facility and I take full responsibility for this action. I authorize the Bristol Fruit
Hills Classic to photograph or video tape my participation in this event. I certify that I am physically fit
and sufficiently prepared myself for this event . I HAVE READ AND UNDERSTAND THE FORM I AM

SIGNING._____________________________________________________________________________

Signature (guardian if under 18) Date

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