Dizzy Fifties Entry Form
(circle choices)
Name: ___________________________________________
Age on raceday: ______________
Birthdate: _____/_____/_______
Gender: ___M______F_____
Event: ____50K______40M_____50M_______
Mailing address: ________________________________
City:____________________________________________
State:__________________________Zip:________
Phone: (_____)______________________________
E-mail:__________________________________________
T-shirt:_____S___M___L____XL____XXL______________
HTC member:________YES_________NO________________
Previous ultras/times:___________________________
_________________________________________________
_________________________________________________
Race Waiver:
I, individually, (and/or as parent, and/or guardian of the named minor) for and in consideration of acceptance of this entry in the aforementioned event, do hereby release, remise, waive, and forever discharge the Road Runners Club of America (RRCA), Huntsville Track Club and any and all other supporting groups of this said racing event, together with all their officers, agents, officials and employees, from any and all liability, claims, demands, actions, or causes of action whatsoever arising out of, or relating to any injury, illness, loss, or damage, including death, relating to participation in the aforesaid event. I further state I am in proper physical condition to participate in this event. In addition, I agree that my participation in this event requires that I will not participate with roller blades, baby joggers, skateboards, animals, headphones, or anything which the race director deems dangerous to myself or other participants and that the race director may remove me from this event for a violation of said policy. I further grant permission to this race and the organization conducting the race and/or agents authorized by them to use any photographs, videotapes, motion picture, recordings and any other record of this event for any purpose. I also agree that if the event is cancelled for any reason that all entry fees are non-refundable.
Signature: ________________________ Date: _____________
Make checks payable to: Huntsville Track Club - $24 before Oct. 1, $32 thereafter
Mail applications to:
Dizzy Fifties Trail Run
2 Saint Charles Road
Huntsville, AL 35801
ALL ENTRY FEES ARE NON-REFUNDABLE