Pie Town  K Fun Run and Walk

September 9, 2017

Registration starts at 8 a.m., Race starts at 9 a.m.

Distance is , or 3.14 miles

Please print clearly

Name___________________________Last Name__________________________

Address______________________City, State, Zip__________________________

Phone___________________________________Age on 9/9_________________

Email_______________________________________________________________

Please circle your adult t-shirt size:    S  M  L  XL

Fee: 20 dollars

Please make check payable to: (please return this form with your check)

JJ Albin

℅ PTRS

PO Box 703

Pie Town, N.M. 87827

This portion must be signed to be considered a participant

In consideration of the acceptance of my entry, I hereby represent that I have read this application fully, have adequately trained to participate in this athletic event, understand the risks involved in strenuous physical exercise, which includes but is not limited to accidents, injury, and death, and therefore I assume all risks associated with participating in this event.  I hereby for myself, heirs, executors and administrators waive and release all claims that I or they may have against the organizers of the event, or the sponsors of the event. I also understand that all decisions of the race officials are final, and entries are nonrefundable.

Participant Signature_________________________________Date______________

Parent/Guardian if under 18____________________________Date______________