First Name:

                Address:    

                       City:    

                     State:    

                         Zip:    

                     Email:    

                         Sex: Select One Male Female

Age On Race Day:    

                Shirt Size: Select One Adult Small Dri Fit Adult Medium Dri Fit Adult Large Dri Fit Adult XL Dri Fit Adult XXL Dri Fit Child Small Cotton Child Medium Cotton Child Large Cotton

       Race Distance: Select One 1 Mile 2 Mile Run 2 Mile Walk 4 Mile Run

I know that running and/or volunteering to work in Mississippi Track Club events are potentially hazardous activities. I should not enter and or run in MTC activities unless I am medically able and properly prepared and/or trained. I agree to abide by any decision of race/event officials relative to my ability to safely compete or assist in this organization's activities. I assume all risks associated with running and/or volunteering to work in MTC events including - but not limited to - falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your acceptance of my entry for racing, I, for myself and for anyone entitled to act on my behalf waive and release the Road Runners Club of America, MTC, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these MTC activities, even though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

     I Accept Waiver: Select One Yes

Signature (Required For All Participants):    

Signature above must be signed by parent or guardian if under 18

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