Saturday, July 21
Benefitting the Brady Volunteer Fire Department ENTRY FEES Adult Registration $30 VIP Registration (Receive a special medal, bring a lawn chair and we’ll provide the entertainment) $45 Student (no tee shirt) $5 Student $15 Sponsor a resident to participate $15
Shirt guaranteed if your entry is received by July 12, 2018. Advanced registration is through July 19, 2018. Registration fee includes a tee shirt and participation medal, unless otherwise indicated. Registration is from 6:30 a.m. to 7:00 a.m. Race begins at 7:15 a.m. NAME:
AGE (as of 07/21/2018):
ADDRESS:
MALE / FEMALE
CITY/STATE/ZIP:
PHONE:
SHIRT SIZE:
EMAIL: PAYMENT ENCLOSED: CASH / CHECK # CHARGE MY: VISA/MC NUMBER:
AMOUNT: EXP:
WAIVER (entry is invalid if not signed) In consideration of the acceptance of this registration entry I, the undersigned, assume full responsibility for any injury or accident which may occur during my participation in this race or while I am on the premises of this event and hereby release and hold harmless the sponsors or promoters or other persons or entities associated with the event or their agents or employees or otherwise. SIGNATURE:
DATE:
Parent’s Signature (if entrant is a minor):
DATE:
Send entry form and payment with checks payable to: Brady/McCulloch County Chamber of Commerce 101 East 1st Street * Brady, TX 76825 For more information call (325) 597-3491 or email
[email protected]
