Pokey Pig 5K Run/Walk | Marion County Chamber of Commerce

Pokey Pig 5K Run/Walk
Official Entry Registration
2012 Marion County Ham Days

8:00 a.m.
Saturday, September 29, 2012
Main Street - Lebanon, KY

5K begins at 8:00 a.m. Please check all information before registering and accepting the release responsibility. For more information, contact the Marion County Chamber of Commerce at 270-692-9594 or info@marioncountykychamber.com.

Fields marked with * are required.

Are you are first-time participant?
Are you a resident of Marion County?
*Please select the sex division for 5K:
*Please select the age division:

*Name:

*Address:

*City:

*State:

*Zip:

*Date of Birth:

*Phone:

Email Address:

*Shirt Size:

For family registrations, please complete the following information for each additional family member.

Name:	Date of Birth	First-Time Participant?	Sex Division for 5K	Age Division	Shirt Size

*Release of Responsibility

In consideration of your accepting my entry, I, intending to be legally bound, do hereby for myself, my heirs, my executors and administrators, do waive and release forever any and all rights and claims for damages I may accrue against all persons and agencies - namely, Marion County Chamber of Commerce and others involved with promoting the race as listing by name, their successors, representatives, and assignees for any and all injuries suffered by me while traveling to and from and while participating in the Pokey Pig 5K on: Saturday, September 24, 2011 in Lebanon, Kentucky.

*I accept this release of responsibility. (required)