TECUMSEH TRAIL MARATHON ENTRY FORM 2006

Entries due by November 22 2006 – subject to field limit

Mail to & checks payable to:

DINO LLC, PO Box 36395, Indianapolis IN 46236

EVENT (circle one): Marathon $50 ……… Fun Run $10 (no t-shirt or awards)

AGE: _____

SEX: M F

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

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

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

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

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

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

T-SHIRT (marathon only) SIZE: S M L XL

Will you need the shuttle bus to the start? Yes No

EMERGENCY CONTACT INFO:

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

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

OPTIONAL:

FINISHER MEDAL (add $6) Yes / No INSCRIPTION (circle): Finish Time or Age Group Placing

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

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: _____________________________