Name __________________________________________________________
Address ________________________________________________________
City/ST/Zip ______________________________________________________
Phone/Text Number:_______________________________________________
E-mail __________________________________________________________
Circle one: male female
Age on race day (Sept.27, 2014 ) ___________
Shirts available for $10.00 each : __________ shirts @ 10.00 each = __________ Please circle shirt size(s) below:
Shirt size ~ Children/Youth: XS S M L XL Adult: S M L XL XXL XXXL
ENTRY FEES ~~ $15-Adult; $10-ages 12 & under
~~ Family rate – 4 or more in the family - $10 ea. (maximum $50.00 for entire family)
~~ After Sept. 18 & race day – Additional $5
TOTAL ENCLOSED $_________
How did you hear about the race?
___ e-mail; ___ school backpack; ___ internet; picked up a brochure @ _________________________; other _____________________________
Waiver: As an entrant in the CTS 1 Mile or 5K Run/Jog/Walk, I assume complete responsibility for injury to me or damage to property which may occur during the event or while I am on the premises of the event. I hereby release and hold the City of Sterling, KS, Communities That Serve, volunteers, sponsors, and all other persons or groups associated with the event from any and all liability associated with this event or otherwise.
Signature________________________________________________________________Date_________
(Parent’s signature required if participant is a minor)
I grant permission for any and all of the forgoing to use any photographs, videotapes or recording or any other record of this event for any purpose whatsoever.
Signature________________________________________________________________Date_________
(Parent’s signature required if participant is a minor)
Make checks payable to: Communities That Serve
Mail, deliver, or fax completed registration form to: or Bring registration to:
Rice County Communities That Serve Rice County Learning Center
217 E. Avenue North 110 East First Street
Lyons KS 67554 Lyons, Kansas 67554
Phone:620-204-0853 Phone: 620-257-7060
FAX: 620-680-6008
Have questions or need more information?
Address ________________________________________________________
City/ST/Zip ______________________________________________________
Phone/Text Number:_______________________________________________
E-mail __________________________________________________________
Circle one: male female
Age on race day (Sept.27, 2014 ) ___________
Shirts available for $10.00 each : __________ shirts @ 10.00 each = __________ Please circle shirt size(s) below:
Shirt size ~ Children/Youth: XS S M L XL Adult: S M L XL XXL XXXL
ENTRY FEES ~~ $15-Adult; $10-ages 12 & under
~~ Family rate – 4 or more in the family - $10 ea. (maximum $50.00 for entire family)
~~ After Sept. 18 & race day – Additional $5
TOTAL ENCLOSED $_________
How did you hear about the race?
___ e-mail; ___ school backpack; ___ internet; picked up a brochure @ _________________________; other _____________________________
Waiver: As an entrant in the CTS 1 Mile or 5K Run/Jog/Walk, I assume complete responsibility for injury to me or damage to property which may occur during the event or while I am on the premises of the event. I hereby release and hold the City of Sterling, KS, Communities That Serve, volunteers, sponsors, and all other persons or groups associated with the event from any and all liability associated with this event or otherwise.
Signature________________________________________________________________Date_________
(Parent’s signature required if participant is a minor)
I grant permission for any and all of the forgoing to use any photographs, videotapes or recording or any other record of this event for any purpose whatsoever.
Signature________________________________________________________________Date_________
(Parent’s signature required if participant is a minor)
Make checks payable to: Communities That Serve
Mail, deliver, or fax completed registration form to: or Bring registration to:
Rice County Communities That Serve Rice County Learning Center
217 E. Avenue North 110 East First Street
Lyons KS 67554 Lyons, Kansas 67554
Phone:620-204-0853 Phone: 620-257-7060
FAX: 620-680-6008
Have questions or need more information?