8/8/2019 Race Entry Form 2010[1]
1/2
LIVERMORE'SANNUALRACETOTHEFLAGPOLE1MileFunRun/Walk
Saturday,November13,2010(8:30a.m.Start)
Thisfunrun/walkwillbenefittheLivermoreGranadaBoosters'ScholarshipFund
forseniorscholarathletesfromLivermoreandGranadaHighSchools.
COURSE
Beginsattheintersectionof2ndStreet&LivermoreAve.andendsattheFlagPoleinCarnegieParkon3rdSt.
Theterrainispaved. Nopets,bikes,skateboardsallowed.
Strollerswithwalkersonly butatyourownrisk.
FEESCHEDULE
Runners&Walkers: $15throughOct.31;$20thereafter
Age10&Under:$10throughOctober31;$15thereafter
REGISTRATION
Commemorative
t
shirt
only
to
entries
posted
marked
on
or
before
10/31/10.
Racedayregistration:7:00
8:00a.m.atCarnegiePark(3rdandJStreets)
Registeronlineatwww.livermoregranadaboosters.orgor
sendthecompletedentryformbelowpostmarkednolaterthan10/31/10
withyourcheckpayableto"LivermoreGranadaBoosters"andmailto
"FlagPoleRace,"2117FourthStreet,Livermore,CA94550"
BIBNUMBERS
Pick up bib numbers at registration table on day of the
race.Runners are divided into age divisions. Please check race
website
prior to race day official start time ay
www.livermoregranadaboosters.org
AWARDS
Anawardwillbepresentedtotheoverallfastestmaleandfemalerunnersandthe
top10runnersineachagedivision.
FORMOREINFORMATION
ContactMikeNagel,RaceDirector,at(925)[email protected]
THEENTRYFORMISONPAGE2OFTHISDOCUMENTBELOW
8/8/2019 Race Entry Form 2010[1]
2/2
LIVERMORE'SANNUALRACETOTHEFLAGPOLE1MileFunRun/Walk
Saturday,November13,2010(8:30a.m.Start)
ENTRYFORM Pleasecomplete&submitoneformperrunner/walker.
CIRCLE:MALEorFEMALE
SCHOOLAFFILIATION__________________________________________________(LivermoreSchoolDistrictorSchoolOrganization)
AGEDIVISIONSarebasedonyourageonraceday11/13/10
CIRCLE*: (10&Under)(1114) (1518) (1929) (3039) (4049) (5059)
(60&Over)
*Pleasecheckracewebsitepriortoracedayforofficialstarttimeatwww.livermoregranadaboosters.org
TSHIRTSIZE
CIRCLE: (YouthSmall) (YouthMedium) (YouthLarge)
(AdultSmall) (AdultMedium) (AdultLarge) (AdultXLarge)
(AdultXXLarge)
TShirtavailabilitycannotbeassuredforracedayregistrants.
Pleaseprint
clearly
the
information
below:
NAME:__________________________________________
EMAIL:__________________________________________
ADDRESS(City,State,Zip):____________________________________________________________________
PHONE:(____)____________
DATEOFBIRTH:________________________
AGEONRACEDAY(11/13):_____________________
WAIVER:
Inconsiderationofmyentryandofmyownfreewill,I,theundersigned,intendingtobelegallybound,dohereby,
formyself,myheirs,executors,andadministrators,waiveandreleaseanyandalllegalrightsandclaimsordamagesImay
accrueagainsttheLivermoreGranadaBoosters,theLivermoreValleyJointUnifiedSchoolDistrict,theCityofLivermore,the
LivermoreAreaRecreation&ParksDistrictorpersons,volunteers,sponsorsororganizationsassociatedwiththeeventfor
anyandallinjuriesordeaththatmaybesufferedbymeorenroutetoorfromtheeventorbecauseofanydissatisfaction
withany
aspect
of
the
event.
Iunderstand
that
participating
in
this
event
is
potentially
hazardous,
and
Ifurther
attest
that
I
recognizethatImustbeingoodhealthandofsufficienttraininginordertoparticipate,andstatefurthermore,thatmyability
toparticipateinandsuccessfullycompeteintheeventhasbeenattestedbyaqualifiedphysician.
Iherebygrantpermission
totheLivermoreGranadaBoosterstousephotosthatmayincludemyselfforpromotionandpublicity.Aspartofmywaiver,I
acknowledgethatIhaveread,understood,andagreetotheinformationcontainedinthiswaiver.
SIGNATURE:__________________________________________________________
DATE:________________
PARENTORGUADIANSIGNATUREIFPARTICIPANTISUNDERAGE18:___________________________________________________
