The Mummy Entry Form

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Print Off this Page and Mail It In

  Mail this page with a check payable to:

          OLD FARTS RUNNING CLUB

                  2010 WOODRUN

                 LOWELL, MI, 49331

Print Name:______________________________________

Address:________________________________________

City:___________________State:_______Zip:__________

Age on Race Day:________ Date of Birth:______________

Gender: circle one:   male   or   female

Email Address:____________________________________

PHONE #: _______________________________________

Each pre-registered race entrant will be put on line on the web page under race entrants to show that your entry has been received and accepted.

CIRCLE THE RACE THAT YOU WISH TO SIGN UP FOR: Registration opens Jan. 1st, 2017

FULL MARATHON  26.2 MILES 

Registration is $75 till July 20th...pre-registered runners for the marathon have their choice of a Jacket, hoody, crew neck sweat shirt or new this year Sweat Pants; all runners get a tee and if you finish...a finisher towel and medal...try at all possible to pre-register by July 20th otherwise you may not get your size or choice. July 21st through August 2nd is $100 and August 3rd through race day is $125.00 so try to pre-register if at all possible.

Race day registration is available for $125.00 so please pre-register! Circle one of the following:

Jacket/ Sweat Pants/Hoody/Crew Neck Sweatshirt.........also circle the  Size:       xs          small        medium     large       xl        xxl  

also write in t-shirt size:__________

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HALF MARATHON  13.1 MILES

Early Registration before July 20th  is $25.00

after July 21st it is $30 and race day registration cost is also $30.00

T-shirts guaranteed for all pre-registered runners...and first come first serve on race day

Circle T-shirt Size:  small   medium   large   xlarge   xx large

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The  5K  ( 3.1 miles)

Early Registration is $15.00 until July 20th

Cost is $20.00 race day registration..tees available while they last on race day

Circle T-shirt Size:   circle one:    small   medium   large   x-large

____________________________________________________________

50 STATES MEMEMBER DISCOUNT...-$5.00 DISCOUNT

OLD FARTS RUNNING CLUB MEMBER #____......-$5.00 DISCOUNT

TOTAL AMOUNT ENCLOSED=____________

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OLD FARTS RUNNING CLUB MARATHON, HALF, AND 5K RACE WAIVER...

WAIVER MUST BE SIGNED IN ORDER TO BE FULLY ACCEPTED. IN REGISTERING FOR THIS RACE I STATE THAT I AM FULLY AWARE, UNDERSTAND, AND ASSUME THE RISK AND RESPONSIBILITY FOR PARTICIPATING IN THIS RACE ON A COURSE WITH VEHICULAR TRAFFIC and SERIOUS TRAILS THAT HAVE HEART ATTACK TYPE UP HILLS. I ALSO STATE THAT I HAVE FULLY CONDITIONED MYSELF TO THE APPROPRIATE LEVEL OF FITNESS. I ALSO WAIVE ALL CLAIMS AGAINST THE RACE DIRECTORS, HOST SITE, SPONSORS, THE CITY OF LOWELL, ETC. AND THAT I AM AWARE OF THE FACT THAT IF THE RACE GETS CANCELLED DUE TO WEATHER OR OTHER REASONS THAT THE RACE ENTRY IN NON-REFUNDABLE.

SIGNATURE:____________________________ DATE:_________________________

PARENT or GUARDIAN MUST SIGN IF UNDER 18 YEARS OF AGE:

_______________________________________DATE:__________________________