5K ROAD RACE
Saturday, February 27, 2010
8 a.m.

Entry - 2010 Missouri
Winter Games
Gender: Male Female Age on 2/27/2010: _____ E-mail: __________________________
Name: _________________________________________ Telephone: ___________________________
Address: _____________________________________________________________________________
City: ___________________________________ State: ______________________ Zip: ____________
I, hereby for myself and my heirs, waive any and all rights for claims on this event in case of injury. I also release and hold harmless any sponsors or organizers of this event including Missouri Winter Games, Ozark Racing Systems, or Smillie's IGA. I, by signing below, specify that I am in acceptable shape and medical condition to compete in this event. I will do my best to follow the course and not be offensive to others while competing in this event. I further state that I am of sound mind and body.
_____________________________________________________________________________________
Signature of Athlete Parent's signature if under 18 yrs. old
Make checks payable to Mo Winter Games and mail to RRS, 3057 S. Fremont, Springfield, MO 65804