19th Annual HOG WILD

HOG WILD 15K RUN & 5K RUN/WALK
Saturday January 28, 2012

Entry Fee: $25.00 with sweatshirt or long-sleeved T-shirt. Mail by 1/17 to guarantee shirt. No Shirt option - $15.00.

Registration & Waiver Form
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 agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to, falls; contact with other participants; the effects of weather, including high heat and/or humidity; 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 the Dothan Runners Club, the City of Dothan, and all race sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the 30th Annual Hog Wild Run.

[FrontPage Save Results Component]

Name: Address:

City:State: Zip:   Phone:

E-Mail Address: : Cell Phone:

Age: (on 1/28/12)      Select Race:    Select Shirt Type:        Select Shirt Size:
                                                                                      *Shirts guaranteed to Pre-Registered
                                                                                                   Entrants Only

        Select Sex

Signature___________________________Date__________________     Mail to: Dothan Runners
(Parent or guardian must sign if entrant is under 18 years of age)                            P.O. Box 887
                                                                                                                                       Dothan, AL 36302
Make check payable to:   Dothan Runners

No entry accepted without required fee. No refunds. All entries must be signed. For more information contact LARRY DYKES at
(334) 792-6021 or drcprez@yahoo.com.

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