P.O.G. 5 Mile Run/Walk
Saturday, July 27, 2019
8:15 a.m.
Start:  Morristown Jr. Sr. High School
215 West Main Street
US Highway 52
Morristown, IN  46161

MAIL IN REGISTRATIONS DUE BY July 21, 2019
$25.00 5 Mile Run/Walk With Short Sleeve T-shirt
$20.00 5 Mile Run/Walk No T-shirt

PRINT, FILL OUT AND MAIL TO:
Energy2Action, LLC
1223 Oak Lane 
Shelbyville, IN  46176


Name:
Address:
Address:
City:
State:
Phone:
E-mail:
Zip:
Male 
Female 
Signature: 
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of  Morristown, Morristown Jr. Sr. High School, Energy2Action, LLC, for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event.  I understand and acknowledge that participating in this run/walk  event may expose me to dangers from both known and anticipated risks.  I understand that the course is not closed to traffic and that I could be at risk from traffic, other runners and cyclists, bad weather, ice, and rough terrain along the course.  I acknowledge that some or all  sections of this run  course might be off road or rough road and may contain areas where I will  be at risk of tripping and falling.  I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor.  I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason.   Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
T-Shirt Size:
Birth Date
Make Checks Payable to:  Energy2Action, LLC
Age on Race Day
NoneSmallMediumLargeX-Large
$25.00 5 Mile Run/Walk With Short Sleeve T-Shirt
$20.00 5 Mile Run/Walk No T-shirt
$________Extra Donation To Morristown CC & Track Team