Official Entry Form for the 10th Annual Good Samaritan
Run for the Ranch

Dec. 27, 2009, 2:30 PM   Trinity Lutheran Church
1415 S. Holland, Springfield, MO

 

First name ___________________________    Last name _______________________________   


Gender:  ___M     ___F       Age on 12/27/09 ______    

 

Address _____________________________    City/State/Zip _____________________________          


Phone ____________________   Email __________________________________

Check only ONE race you are entering:          ___5K      ___10K    ___Half marathon    ___Full Marathon

 

T-Shirt size:     ___S      ___M      ___L      ___XL

If registering after Dec. 12, pick up shirt at RRS beginning Jan. 10, 2010    Mail shirt to you? ____ (add $5)

 

5K/10K: $15; Half Marathon: $30; Full Marathon: $45

After 10/31/09: 5K/10K: $15; Half Marathon: $35; Full Marathon: $50

Day of race: 5K/10K: $20; Half Marathon: $40; Full Marathon: $55

 

Extra donation to Good Samaritan Boys Ranch (optional) $ _____ Thank you!

 

Total rec’d: ______           ____cash or check# _______

Make checks payable to OMRR. Mail to RRS, 3057 S. Fremont, Springfield, MO, 65804

 

WAIVER: I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I assume all risks associated with running in this event including, but not limited to, falls, contact with other participants, the effects of the weather, traffic, and the conditions of the road. 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 Ozark Mountain Ridge Runners, Ridge Runner Racing Systems, Ridge Runner Sports, the City of Springfield, and all other sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any lawful purpose.

 

Signature: _______________________________________ Date ____________

 

Parent MUST sign if entrant is under 18 yrs. of age