Prairie Striders Track Club

Bob Bartling Hobo Day Run 2012 Entry Blank


Name:___________________________________________________________
Street:___________________________________________________________
City: __________________________ State: _________ Zip:__________
E-mail:___________________________________________________________
* Internal use only -- email list will not be sold
Age on Raceday         Male    Female
Registration Fee: $15.00 by Nov 4, $20.00 Race Day.
Preregistered entries may be mailed or delivered by November 4 to:
Steve Britzman, 521 6th St. Suite 104, Brookings, SD 57006. (521 Sixth Street is across the street from First Bank & Trust building.)

Make Checks Payable to "Prairie Striders"

Legal Waiver
IN CONSIDERATION OF ACCEPTING THIS ENTRY, I HEREBY, FOR MYSELF, MY HEIRS AND PERSONAL REPRESENTATIVES, WAIVE AND RELEASE ALL RIGHTS AND CLAIMS FOR DAMAGES I MAY HAVE AGAINST THE PRAIRIE STRIDERS ORGANIZATION, THE HOBO DAY RACE SPONSORS, AND TACO JOHN'S, THEIR AGENTS, REPRESENTATIVES, SUCCESSORS AND ASSIGNS, FOR ANY AND ALL INJURIES AND DAMAGES SUSTAINED BY ME AT THIS EVENT AND I VOLUNTARILY ASSUME THE RISKS OF PARTICIPATING.

Signed (Participant) _____________________________________Date ______

Signed (Parent or Guardian if under 18) ________________________Date ______

Return Entries To:
Prairie Striders c/o Steve Britzman
521 6th St. Suite 104
Brookings, SD 57006

For More Information Contact:
Prairie Striders
P.O. Box 267
Brookings, SD 57006
(605) 697-9058 (Steve)
(605) 940-7524 (Kurt)
(605) 692-2414 (Bob)


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