Mainstay Mountain Medley Printable Registration Form

Start Times: Please arrive early as the roads close at 8:50 am

10 mile - 9:00 AM 5K race - 9:15 AM 1 mile walk/run - 9:30 AM

Packet pick up at Mainstay´s Purple Ribbon on April 14-16, 8:30-5:00
Packet pick up and race day registration 7:30-8:30 a.m.
$5 dollar discount if registration is received by March 21.

Please fill in all required fields in the form below.

First Name:	Last Name:
Street Address 1:
Street Address 2:
City/State/Zipcode:
E-mail:		Phone:

Select Event:	$5 discount if registration received by March 15.
T-Shirt Size:
Age on Race Day:	Note: For Runner's Only
Gender:	M F
Emergency Contact		Phone:

Additional Donation: $
Total Due: $

WAIVER: Upon acceptance of my entry, I, for myself, my heirs and assigns, hereby release the sponsors, officials and volunteers of the Mainstay Mountain Medley from any and all liability arising from illness, injury, or death I may suffer as a result of participation in the event. I attest that I am physically able and have sufficiently trained for this event and am aware that participation in this event could result in physical injury. Should officials determine that completion of the event would be injurious to my health, I consent to be removed from the event and be treated by designated medical personnel. I agree to accept the decisions of the officials as final.

Name:
Guardian if under 18:
Date (MM/DD/YY):

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