2005 David G. "Doc" Sears Fall Classic

NAME: ____________________________________________ PHONE: (        ) ____________________

ADDRESS: _________________________________________

CITY: __________________________________ STATE: ________ ZIP: _______________

EMAIL: ___________________________________________________________________

GENDER:  Male  or  Female            AGE: ______

CHOOSE ONE:        _____2 Mile Walk        _____5 Mile run

T-Shirt:  Yes  or  No                If Yes, Size:        S        M        L        XL

FEES

Please read the following statement and sign below before submitting entry.

In consideration of the acceptance of my entry, I do hereby acknowledge that I assume all risks resulting therefrom, and I do hereby, for myself, my heirs, my executors and/or administrators, waive, release, and forever discharge any and all sponsors and organizers, their officers, agents and assigns, the race director and volunteers from any and all liability arising from illness, injuries, or damages I may suffer as a result of my participation the David G. "Doc" Sears Fall Classic.  I understand that traffic control on the course will be limited and that I must watch for vehicles at intersections and on the roadway.  This entry is non-transferable and non-refundable.

Signature: _______________________________Date:____________  

Signature: _______________________________Date:____________

                Parent or Guardian if under 18 years of age

MAIL ENTRY TO:

• MIKE COLLINS, 
• C/O LCSC Cross Country
• 500 8th Avenue
• Lewiston, ID  83501