Camp Nelson 5Kxc 2008

Registration Form

Please complete all fields.
First Name
Last Name
Street Address
City
State
Zip Code
Email Address
Phone Number
Date of Birth
Age On Race Day
Division - Age on Race Day	-- MENS' AGE DIVISIONS -- 13 & Under 14 - 16 17 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 & Over -- WOMENS' AGE DIVISIONS -- 13 & Under 14 - 16 17 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 & Over
Sex	Male Female
T-shirt Size	Small Medium Large XLarge
Release of Responsibility By signing above I acknowledge that in consideration of the acceptance of my entry, I for myself, my heirs, executors and administrators, do hereby release and discharge Nicholasville/Jessamine County Parks & Recreation and all sponsors and associates of this event from any and all claims in said event. I certify that I have full knowledge of the risks involved in participating in this event. I release publishing rights of photographs taken of me during the Camp Nelson 5Kxc Race for purposes of coverage and publicity for this and future events sponsored by Nicholasville/Jessamine County Parks & Recreation. I Accept The Terms of This Waiver electronic signature Date Accept as Parent or Guardian (participant under 18) electronic signature Date

Copyright © 2007 Nicholasville/Jessamine County Parks & Recreation. All rights reserved. 402 Park Drive · Nicholasville, KY 40356 · Telephone: 859-885-9787 · Fax: 859-881-5017 · Email: njcpr@windstream.net Website Design by NetMediaOne