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NAME:___________________________________________________________________
ADDRESS:_______________________________________________________________
CITY, STATE, ZIP:_________________________________________________________
PHONE:____________________________ T-SHIRT SIZE (circle one): S M L XL
DATE OF BIRTH:_______________ AGE (on 10/27/07):_____ SEX (circle one): M F
E-MAIL:__________________________________________________________________
WAIVER: In consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release Jacksonville State University, all sponsors, volunteers and supporters of this race, with their representatives and successors from all claims or liabilities arising out of my participation in this event. I grant permission to everyone to use any photographs or records of this event for media use or any other legitimate purpose, without compensation to me. Fee is $12 in advance or $15 race day.
_________________________________________________________________________
SIGNATURE (Parent or Guardian if under 18 years old) DATE
For Anniston Runners Club members, fee is $10 in advance or $15 race day.
Make check payable to Gamecock Gallop. Mail by 10/20/07 to:
Gamecock Gallop 5K; JSU Dept of HPER; 700 Pelham Rd N; Jacksonville, AL 36265
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