Electric City Gobbler 5K Entry Form
Seventh Annual Electric City Gobbler 5K
Run & Walk
Date: November 25, 2010 - Thanksgiving Day!
Time: 8:30am
Location: Anderson Mall - Main Entrance - Clemson Boulevard, Anderson, South Carolina
Course: Certified course on city streets around Anderson Mall. Fast and safe! (SC04033BS)
Registration: _____ Male _____ Female
Electric City Gobbler 5K Long-Sleeve T-shirts available to All pre-registered runners – choose one:
Pre-Register by November 15, 2010.
T-Shirt Size (Circle One):
Adult - Small Medium Large X-Large
Youth - Medium Large
_____ 5K Run - $20 – through November 15; after November 15 - $25
_____ 5K Walk - $20– through November 15; after November 15 - $25
_____ Cross Country Team Members - $15 – through November 15; after November 15 - $25
Cross-Country Team Name: ________________________________________
Birth Date: _____ / ______ / ______ Age on Race Day: ________
Name __________________________________________________________________________________________
Address ________________________________________________________________________________________
City ________________________________________________ State ___________ Zip _______________________
Tel# __________________________ E-Mail ___________________________________________________________
Waiver of Liability
In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators, and assigns, release and discharge the sponsors and
directors of this race and their agents and employees from any and all claims for damages suffered by me as the result of my participation in or traveling to or
from the said event to be held on November 25, 2010. I specifically release and discharge said operators and sponsors from all injuries or damages arising from
or contributed to by any physical impairment or defect I may have, whether latent or patent, and agree that they are under no obligation to provide a physical
examination or other evidence of my fitness to participate in such event the same being my sole responsibility. I also give my permission for the free use of my
name and picture in any broadcast, telecast or other written account of the event.
Signature __________________________________________________ Date ______________
Signature of Parent or Guardian (if under 18) ________________________________________
Send Entry Form & Check to:
Electric City Gobbler, c/o ECRC
129 Garden Park Drive
Anderson, SC 29621
Seventh Annual Electric City Gobbler 5K
Run & Walk
Date: November 25, 2010 - Thanksgiving Day!
Time: 8:30am
Location: Anderson Mall - Main Entrance - Clemson Boulevard, Anderson, South Carolina
Course: Certified course on city streets around Anderson Mall. Fast and safe! (SC04033BS)
Registration: _____ Male _____ Female
Electric City Gobbler 5K Long-Sleeve T-shirts available to All pre-registered runners – choose one:
Pre-Register by November 15, 2010.
T-Shirt Size (Circle One):
Adult - Small Medium Large X-Large
Youth - Medium Large
_____ 5K Run - $20 – through November 15; after November 15 - $25
_____ 5K Walk - $20– through November 15; after November 15 - $25
_____ Cross Country Team Members - $15 – through November 15; after November 15 - $25
Cross-Country Team Name: ________________________________________
Birth Date: _____ / ______ / ______ Age on Race Day: ________
Name __________________________________________________________________________________________
Address ________________________________________________________________________________________
City ________________________________________________ State ___________ Zip _______________________
Tel# __________________________ E-Mail ___________________________________________________________
Waiver of Liability
In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators, and assigns, release and discharge the sponsors and
directors of this race and their agents and employees from any and all claims for damages suffered by me as the result of my participation in or traveling to or
from the said event to be held on November 25, 2010. I specifically release and discharge said operators and sponsors from all injuries or damages arising from
or contributed to by any physical impairment or defect I may have, whether latent or patent, and agree that they are under no obligation to provide a physical
examination or other evidence of my fitness to participate in such event the same being my sole responsibility. I also give my permission for the free use of my
name and picture in any broadcast, telecast or other written account of the event.
Signature __________________________________________________ Date ______________
Signature of Parent or Guardian (if under 18) ________________________________________
Send Entry Form & Check to:
Electric City Gobbler, c/o ECRC
129 Garden Park Drive
Anderson, SC 29621
Electric City Running Club
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