Make checks payable to:
Firecracker 5k
Fill in the information, print it out, and mail to:
Firecracker 5K
1004 Bank Street
Webster City, IA 50595
Race day: Monday, July 5th, 2010 at 8:00 a.m.
First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip Code:
Phone #:
(
)
-
Country (if not USA)
Gender:
Male
Female
Your age on race day:
-Shirt Size-
Kids - S
Kids - M
Kids - L
S
M
L
XL
XXL - add $1
-Race-
$15 - 5k Race Early Entry
$20 - 5k Race Late Entry (after June 27)
$8 - Kids Fun Run
$10 - Kids Fun Run (after June 27)
Note: Cannot guarantee t-shirts for everyone who signs up on race day
In consideration of acceptance of this entry, I waive and release the City of Webster City and Recreation Department, supporting organizations, sponsors, contributors, race officials and volunteers from liability for any injury or accident I may suffer during the course of this event.
I agree to the above waiver
Date:
If printed, please Sign: ________________________