Mad Co Miles Sign-Up

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Name *

Email Address *

In which Group do you want to begin? (See initial goals by Group name.) Once you complete a challenge, you can add those miles to have a head start on the next challenge! *

Miles Across Madison (31 miles)

Steppin' through the State (150 miles)

Crossing Carolina (500 miles)

Movin' Across America (3100 miles)

It is okay with me if you want to share any milestones that I meet within my Group. *

Yes

T-Shirt Size (for future prizes earned) *

XXL

Other:

Liability Waiver: In consideration of my (and/or my child’s) participation in this activity, I hereby release and discharge the Madison County Public Libraries and its representatives, successors, and assigns, from any and all liability arising from accident, injury, and illness that I (he/she) may suffer as a result of my (our) participation in this activity. I (we) also will follow the rules and regulations set by the Organization and above named parties. Parent or guardian must sign for anyone age 18 and under. *

I accept the above Liability Waiver.

I do NOT accept the above Liability Waiver.

Media Release: I do hereby grant and give these groups the right to use my or my child(s) photograph or image with or without my or my child's name, both singly and in conjunction with other persons or objects and presentations, advertising, publicity, and promotion relating thereto. *

I accept the above Media Release Statement.

I do NOT accept the above Media Release Statement.

I understand that I should consult with my doctor prior to beginning any new physical activity or exercise program. *

Yes

If you are a Madison County resident, please select your home library branch. Note: You do not have to be a Madison County resident to participate in this program.

Hot Springs

Mars Hill

Marshall

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