LITTLE MOUNTAIN
USAT&F CERTIFICATION Mountain Run 2007 COMPUTERIZED FINISHES
AGE GROUPS: 13 - Under 25 – 29 40 – 44 55 – 59
14 – 19 30 – 34 45 – 49 60 – 64
20 – 24 35 – 39 50 – 54 65 – Over
FEES: $20 Pre-registration (by July 21, 2007)
$25 Day of Race
(Includes T-shirt and water bottle while they last)
Please fill out the following information and return by July 21, 2007
Little
Little
Please make checks payable to “The Little Mountain Reunion Association”
Whitney Kibler Email: majawhde@gmail.com
Holly McGinn Phone: (803) 351-2846 or (803) 233-3598 Email: Uscgirl086@aol.com
8K Certification # 98012BS
Name_____________________________________________ Emergency Contact (Name and Phone)
Address___________________________________________ ________________________________________
City/State__________________________________________ Age (8/1/2007) _____ Male_____ Female_____
Zip Code__________________________________________ Shirt Size M_____ L_____ XL_____
In consideration of the acceptance of this entry, I wave any and all claims for myself, my heirs, or assignments against and I hereby release the Little Mountain
Reunion Association, the town of
them, including any injury or illness which might result from my participation. I further state that I am in proper physical condition to participate in this event. I also
give my permission for the free use of my name and my picture in any broadcast, telecast, or other account of the aforementioned event.
___________________________________ ______________________________________
Signature of Runner Parent’s Signature if under age 18