Bob Bartling Hobo Day Run 2010 Entry
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| Name:___________________________________________________________ |
| Street:___________________________________________________________ |
| City: __________________________ |
State: _________ |
Zip:__________ |
| E-mail:___________________________________________________________ |
| Registration Fee: |
$13.00 by October 23, $15.00 Race Day. |
Preregistered entries may be mailed or delivered
by October 23 to:
Steve Britzman, 521 6th St. Suite 104, Brookings, SD 57006.
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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