HEART OF THE PRAIRIE ROAD RACES

HEART OF THE PRAIRIE Road Race 8k, 5k, 2k, WALK/RUN REGISTRATION

RACE REGISTRATION

Waiver: I know that running a race is a potentially hazardous activity. I enter
this race certifying that I am medically able and properly trained. I also know
that, although police protection will be provided, there may be traffic on the
course route. I also assume any and all other risks associated with the
running of this event, including but not limited to falls, contact with other
participants, the effects of the weather, including high heat and/or humidity
and condition of the roads.

Signature ____________________________________________________
By parent or guardian if participant is under 18 years of age

Print out this form and mail it with $15 to: Belview Booster Club, Heart of the Prairie Road Race, Box 4, Belview Mn 56214 or
email it to sdaniel@redred.com to pay by credit card or PayPal ;or click the submit button on the bottom of the form.For any questions
please call 507-381-9862 (Shirley).If you do not want a t-shirt, you can pay $8.00 for your participaation in the race.

Race Entered:
Age on Sept 17, 2011:
Sex:
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Comments:

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HEART OF THE PRAIRIE Road Race 8k, 5k, 2k, WALK/RUN REGISTRATION