8TH Annual CANNONBALL RUN
ENTRY FORM & RACE SCHEDULE
Sept. 1, 2012 Friday - Sept. 7, 2012
All pre-registration entries must be post-marked by this date. Race packet pickup at
Entries post-marked after this date will be the same fee but a Trinity Park - 4:00 - 7:00 p.m.
t-shirt may not be included. Payment must accompany your Saturday - Sept. 8, 2012
application for entry. Check or Money Order only. Registration - 8:10 a.m.
Entry fee is non-refundable. Race - 5K - 9:00 a.m. 10K - 9:05 a.m.
1 Mile Run/Walk - 9:00 a.m.
Last Name_____________________________________________________ First Name_____________________________________________________
Address_________________________________________________________City__________________________State _______________Zip_________
Phone________________________________________ Email______________________________________________ Age on Sept. 8, 2012___________
CHECK ALL THAT APPLIES
Category: 15 & under______ 16 - 19______ 20 - 29______ 30 - 39______ 40 - 49______ 50 - 59______ 60 – 69______70—79_____ 80 +_____
Sex: M______ F:______ Youth______ Senior______
5K Run______ 10K Run______ $25.00 - (Participation medal and t-shirt)
1 Mile Run/Walk ______ $15.00 - Children $15.00 - Family (4 or more)- $35.00 - (Participation medal, ribbon and t-shirt) T.
T-Shirt size: Adult: S_____ M_____ L_____ XL_____XXL_____ Youth: XXS_____XS_____ S_____ M_____ L _____
All Proceeds after expenses go to support the Veterans Assistance Fund of Clinton County New York.
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WAIVER OF LIABILITY: In consideration of your accepting this entry, I, the undersigned, intended to be legally bound, for myself, my family, my heirs, executors, & administrators, forever waive, release & discharge any & all rights & claims for damages & causes of suit or action, known or unknown, that I have against the Battle of Plattsburgh Commemoration Celebration, the Battle of Plattsburgh Association, the City of Plattsburgh, all race committee person, officials & volunteers, & all sponsors of the Cannonball Fun Run & relate events & their officers, directors, employee, agents, & representatives, successors, & assigns, for any & all injuries suffered by me in this event. Latest that I am physically fit, am aware of the dangers & precautions that must be taken when running in warm or cold conditions, & have sufficiently trained for the completion of this event. I further assume and will pay my own medical & emergency expenses in the event of an accident, illness, or other incapacity regardless of whether I have authorized such expense. I have read the waiver carefully and understand it.
Signature______________________________________________________________________________ Date______________________________
Parent or Guardian (if under 18) ____________________________________________________________Date______________________________
Make Checks payable to: Battle of Plattsburgh Commemoration (BOPC)
Cannonball Run - 94 Bradford Road - Plattsburgh, NY 12901 Phone: 518-563 6186 Email: cannonballrun2012@gmail.com
