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Cobb Corn Roast 1st Annual Fun Run/Walk
Official Entry Form
5 Mile Run / 2 ½ Mile Walk
Saturday, August 14, 2010
Run Start Time: 9:30 a.m. at Cobb Community Center
Walkers immediately following all runners
Registration Fee: $12.00 Early Entry by August 4, 2010
$15.00 After August 4, 2010 (shirt size not guaranteed)
Please sign me up for the: ____ 5 Mile Run OR _____ 2 ½ Mile Walk
Select T-Shirt Size:
Adult: Youth:
____ Small ____ Small
____ Medium ____ Medium
____ Large ____ Large
____ X-Large ____ X-Large
First Name: ________________________ Last Name:____________________________
Address: ________________________________________________________________
City: ____________________ State: _____________________ ZIP: ________________
Email address ___________________ Emergency Phone Number ( )______-_______
_____ Female _____ Male Age as of 8/14/10 ________
Mail official entry form and fee to: Colleen Fingerson
P.O. Box 1
Cobb, WI 53526
Make Checks Payable to: Cobb Corn Roast
In consideration of the acceptance of my entry in the Cobb Corn Roast Annual Fun/Run Walk held on August 14, 2010, I release the Cobb Corn Roast Committee and other individuals or entities who are in any way connected to the event, including any volunteers assisting with the event from any liability or claims for injury or illness that I might sustain during my participation in these events or that is in any other way related to these events. I understand that this release applies to myself and my personal representatives, heirs and assigns. I know that running or walking is a potentially hazardous activity, but represent that I am trained adequately and am medically able. I assume all risks associated with running or walking, including but not limited to falls, contact with other participants, effects of weather including high heat and/or humidity, traffic and the conditions of the roads.
Signature: _______________________________Date: _____ __________________________________
Signature of Parent or Guardian if under 18
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Iowa County Government
Iowa-Grant School District