Towns County Chamber of Commerce

5 K Jingle Jog Internet Application

5K Run/Walk
Male Female
Age on Race Day__________
T-Shirt Size: Small Medium Large X-Large XX-Large

Name:_____________________________________________________

Address:_________________________________________

City:___________________State:________Zip:_______Phone:_______

Running Club or Group I am with______________________________

Did you participate last year?____________

In consideration for allowing me to participate in this event, I (and my parents if under 18) for themselves, heirs, administrators and executors hereby waive and release any and all persons, property owners, supporters, volunteers, or entities in any way connected with this event from any and all claims or damages of whatever kind arising out of my participation in this event. I further certify that I have been trained for this event and am in proper physical condition.

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Signature of Runner  Signature of Parent (if under 18)

 

Must be Pre-Registered by November 29, 2002
Please mail application with check for $20.00 made payable to:

Towns County Chamber of Commerce
1411 Fuller Circle
Young Harris, GA 30582


Sixth Annual Jingle Jog
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