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$10 Pre-­‐register without TShirt $20 Pre-­‐register with TShirt Pre-­‐register deadline Wednesday June 17th $15 Race day registration Name:_____________________________ Age on April 26th 2014:________________________ Address:_________________________________________________________ Male / Female (Check one) Phone:_______________________________ Email_________________________________________ Entry Fee:__________________________ T: shirt Size: S M L ✔ XL (Check one) Make checks payable to Freedom Days Picnic Mail entry form and payment to Freedom Days, PO BOX 296, Celina OH 45822 or Drop off at Celina Chamber of Commerce I hereby release and discharge Freedom Days Picnic and all other event sponsors and officials from any liability for injury or illness which may directly or indirectly result from participating in this race. I attest I am physically fit and have sufficiently trained for this race. Signature of participant and parent/guardian if participant is under 18: ______________________________________________________________________ Cash Prizes Door Prizes E
Male & Female Age Groups 9 Yrs. & Under 10-­‐19 * 20-­‐29 * 30-­‐
39 * 40-­‐49 *50-­‐59 * 60 & Over Awards To Top 3 in Each Age Group & Top Male & Top Female Overall! A
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