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

Fees prior to April 30th
10 Mile - $35 · 5K - $20 ·1 Mile Walk/Run - $17

Packet pick up at Mainstay´s Purple Ribbon on April 29th, 10:00-6:00

Race day registration and packet pickup 7:30-8:30 a.m.
Race day registration fees are 10 Mile - $40 · 5K - $25 ·1 Mile Walk/Run - $22

Please fill in all required fields in the form below.

* Required Fields - Please fill in below. Form must be received prior to race day.

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

* Select Event:	$5 Discount if registered by March 15
* Age on Race Day:	Note: For Runner's Only
* Gender:	M F
* Emergency Contact		* Phone:

Lunch Registrations:

Event Participant: $8
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10
Guest Name: $10

Additional Donation: $
* Total Due: $	$2 discount for Four Season's Running Club
	Members

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:
Signature:
Date (MM/DD/YY):

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Mail Registration To:

Mainstay, Inc.
133 Fifth Ave W
Hendersonville, NC 28792