Huntsville David McKannan Memorial 5K and Fun Run Official Entry Form

Please clip out the entry form and mail with the appropriate fees.  Please print legibly and complete fully.
Incomplete or illegible applications may not be accepted.  See you on race day.  Good luck.


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Last____________________________  First_________________________________ Circle sex             Male       Female

Street_________________________________________________________________ AGE (On Race Day)_______  Birthday  _____/_____/_____


City___________________________________ ST__________ ZIP_______________ HTC Member     Yes      No


Phone_________________________    

Email_________________________    

Emergency Contact    Name:_________________________    Phone_________________________    

Event (Circle One)      [5k]         [Kids 1-Mile Fun Run (FREE)]

T-Shirt size (Circle One)    S    M    L    XL    2XL



[ ]By checking the box to the left I agree that my participation in this event requires that I will not participate with roller blades, baby joggers, skateboards, animals, headphones, iPods, MP3 players or anything which the race director deems dangerous to myself or other participants and that the race director may disqualify me from this event for a violation of said policy.

Race Waiver: I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge the Road Runners Club of America, Huntsville Track Club and any and all other supporting groups of this said racing event, together with all their officers, agents, officials and employees, from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event.  I further state I am in proper physical condition to participate in this event. In addition, I agree that my participation in this event requires that I will not participate with roller blades, baby joggers, skateboards, animals, headphones, or anything which the race director deems dangerous to myself or other participants and that the race director may remove me from this event for a violation of said policy.  I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion picture, recordings and any other record of this event for any purpose.  I also agree that all entry fees are non-refundable and that this entry is non-transferable and non-deferrable.


Signature: _____________________________________________Date: _____________________
Parent/Guardian Signature if under 19:_________________________________________________________
_________________________________________________



Official Use Only
Race Number   [ ]   Paid [ ]
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Mail application to:
deciBel Research
Attn: David McKannan 5k
325 Bob Heath Dr
Huntsville, AL 35806

Make checks payable to the Huntsville Track Club.

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