The 27th Fort-To-Fort Relay Road Race...Run For Respect

Entry form

To benefit Ten Thousand Helpers' programs for persons who are homeless and mentally ill.

Question Title

* Personal information

(each team member are required to complete an individual entry form)

Team category describes how you want your team to be classified, (ie. teachers, walkers, lawyers, military, etc) basically any category you come up with.

Registering here means that you agree to pay your entry fee before or on race day...

Last Name:

First Name:

Age:

Sex:

Mailing Address:

Phone:

e-mail Address:

Country of Residence:

Team Name:

Your Team Category:

Team Member #1

Team Member #2

Team Member #3

Team Member #4

RELEASE--WAIVER--STATEMENT OF FITNESS
I entering this footrace, hereby attest that I have trained for and am in proper physical condition as ascertained by a licensed physician, to run/walk 4 miles in high heat and humidity with limited traffic on public roads/streets. I further release all sponsors, volunteers, organizers, from all claims resulting from loss, injury or illness resulting from my participation in this race and give permission to use my name, and or images/pictures in any account of this race.

Question Title

* Putting your name here is your signature...

Signature (put your name here please):

Date:

If you are under the age of 18 please have your parent or guardian sign here (parent/guardian put your name here please):

Date:

RACE NUMBER: