1. sports
2. auto racing

Official Use Only: Runner #______ Shirt: Y N
Date received: _____________ Paid: __________
Cotter Warrior Foundation 5K/10K
Registration Form
Saturday, April 4, 2015 • Cotter Springs, AR
Race Start: 7:30 am, rain or shine
TIMES WILL BE POSTED ON
Arkansasrunner.com!
Last Name:______________________ First: _________________________
Sex:
M
F
Age on race day, 4/4/15
Address:
City
State:
Please circle your
choices, one in
each column:
5K
RUN
Zip:
Email:
Shirt Size: (please circle) S
M
L
XL
XXL
Kids’ sizes: S
M
L
10k................WALK
RELEASE:
I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and run in this race unless
I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run.
I assume all risks associated with running and volunteering to work in club races 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 accepting my
entry, I, for myself and anyone entitled to act on my behalf, waive and release the Cotter Warrior Foundation 5K/10K and all sponsors,
their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or club activities
even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all
the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.
I understand that my entry fee is non-refundable.
Signature:
Date:
Parent Signature (if under 18 years):
Date:
FEES: (nonrefundable)
5K
Under 18:
$15 preregistered
$20 day of race
5K
Adult:
$20 preregistered
$25 day of race
10K
Under 18:
$20 preregistered
$25 day of race
10K
Adult:
$25 preregistered
$30 day of race
For more information
call 870.435.6323
or email:
[email protected]
[email protected]
Make checks payable to: COTTER WARRIOR FOUNDATION
Please put ATTN: “Race App” on
envelope
Mail entry form & check to:
COTTER WARRIOR FOUNDATION
PO BOX 362
GASSVILLE,
72635
Gassville, AR AR
72635
Registration on day of race: 7:00 am -7:20 am
Walk or Run
Make sure your application is postmarked by March 13 to
get your t-shirt on race day!
Other registrants will get their shirts after the race.