2007 Grateful Gobbler Registration
Form (print)
Checks payable to: Homeless
Coalition. Please send completed form to ->
The Homeless Coalition
-> P.O. Box 3690
->
Chattanooga, TN 37404
#1 Registrant:__________________________________________
Telephone: _______________ Email:
______________________
Address:______________________________________________
City/State/Zip:__________________________________________
#2:________________________
#3:________________________
|
Number In Advance After Nov. 13 Total |
Individual: ______
@ $20
@$25
$_____
Children:
______
@ $10
@$10
$_____
Leadership: ______
@ $50
@$50
$_____
Additional Contribution:
$_____
Total:
$_____
Shirt Size: ____ Sm ____ Med ____ Lg ____XL
Agency
Designation–If you choose to designate a specific Homeless Coalition member
agency to benefit from your contribution, please insert the name below (list
available at
Coalition).
_________________________________________________________
Participant Release
I know that walking or running a road
race is a potentially hazardous activity, and I should not enter or run 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 this run. I assume all
risks associated with running this event., including but not limited to: falls,
heat and humidity, traffic, and the conditions of the road, all such risks being
known and appreciated by me. Having read this waiver and for myself 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 Chattanooga Homeless
Coalition, the Chattanooga Track Club, the City of Chattanooga and all sponsors
their representatives and successors from all claims or liabilities of any kind
arising out of my participation in this event even though that liability may
arise out of negligence or carelessness on the part of the persons named in this
waiver. Fees are nonrefundable.
#1 Registrant:___________________________________________
#2
Registrant:___________________________________________
[Signature Required for each Participant -
Additional signatures can go on back]