360 Minutes @ Muscatatuck Entry Form 2008

ENTRY FEES per person

Team: $35    after June 27: $45

Solo: $40… after June 27: $50

 

ALL RUNNERS MUST SIGN A LIABILITY RELEASE FORM AT THE RACE VENUE. No refunds.

Mail entry with check payable to: DINO PO Box 36395, Indianapolis IN 46236

Or register online at www.active.com

DIVISION (Circle one):

Team: 2Coed, 2Male, 2Women, 2Masters, 4Coed, 4Male, 4Women, 4Masters, 4HSmale, 4HSfemale, 4HScoed

Solo: Male, Female, Masters Male, Masters Female

 

NUMBER OF RUNNERS ON TEAM: __

Mail all team members’ entry forms together. Enter the same team name in TEAM/SPONSOR blank below.

TEAM NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

AGE: _____ SEX: M__ F__

LAST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

FIRST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

STREET ADDRESS: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

CITY: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| STATE: |__|__|

ZIP: |__|__|__|__|__| PHONE#: (____)|__|__|__-__|__|__|__|

E-MAIL: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

T-SHIRT SIZE: S___ M___ L___ XL___

 

Extra meals for spectator(s) $8 each. Indicate quantity: ___

 

EMERGENCY CONTACT INFO:

NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

PHONE#: (____)|__|__|__-__|__|__|__| or SPECTATOR AT THE EVENT ___

 

OPTIONAL:

TEAM/SPONSOR: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: _____________________________