Mail-in Registration Form
Paper form deadline: postmarked Saturday, November 22, 2014
Races Start – December 6, 2014, 12:00 noon
Recycle this paper and register online by noon through December 4 at:
https://events.bytepro.net/2014Farmland5K
Race Website: www.xcchallengetcruns.com
Facebook: www.facebook.com/Farmland5K
First Name______________________________________________________M.I. _____ Last Name__________________________
Address____________________________________________________________________________________________________
City _______________________________________________________________ State_____ Zip ___________________________
Phone _______________________________ Email _________________________________________________________________
Gender: (check which) M [ ] F [ ] Age as of December 6: _______ Date of Birth: ___ / ___ / ___
Race Category: [ ] 5K Run Only [ ] Free for All Bike Only [ ] Combo 5K Run and Free for All Bike
Optional Section for Team Competition:
I would like to form a team, please contact me at this email address:_________________________________________________
Reminder, Teams must be formed by November 22, 2014)
Fees for the 5K Run and/or the Free for All Bike:
5K Run or Free for All Bike:
Combo 5k Run and Free for All Bike:
$35 each
$55
Eve of Race in person December 5:
5K Run or Free for All Bike Walk Up Registration in person December 6:
Combo 5K Run and Free for All Bike:
$40 each
$60
Race Day Registration in person December 6:
5K Run or Free for All Bike Walk Up Registration in person December 6:
Combo 5K Run and Free for All Bike:
$45 each
$65
NOTE: Great Family Rates Available, only through online registration!
Total Payment Due:
Individual Entry Fee $_____
check or money order only, payable to: “Wellness Professionals”
TOTAL ENCLOSED:$ ___________
Please make check or money order only, payable to: “Wellness Professionals”
Send registration form and payment by mail, postmarked November 22 to:
Farmland 5K, 1247 Fairwood Lane, Traverse City, MI 49696
Phone: 231-631-2195 | www.xcchallengetcruns.com
Participant Waiver for Race Registration
I know that running [volunteering for] a road race is potentially hazardous activity, which could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I
certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the
right of any official to deny or suspend my participation for any reason whatsoever. I attest that I have read the rules of the race and agree to abide by them. I assume all risks associated with running in this event,
including but no limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, extreme cold and precipitation, traffic and the conditions of the road, all such risks being
known and appreciated by me. I understand that skis, bicycles, baby joggers, animals, and personal music players are not allowed in the race and I will abide by all race rules. Having read this waiver and knowing these
facts and inconsideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Farmland 5K, the city of Traverse City, GT County, East Bay Township, TCAPS, all event
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. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. I understand there are no refunds
or exchanges for any reason.
Athlete’s Signature: ________________________________ Date: ________Signature of Parent/Legal Guardian if Participant is a Minor: _______________________