Name____________________________________

Address__________________________________

City__________________St_______Zip________

Age_____Sex_____Phone (____) _____-_______

Check Event: ______Run OR ______Walk

E-mail___________________________________
[E-mail addresses will only be used to notify
racers of upcoming HHC sponsored races.]

Check Distance: __ Mini __ 10 Mi __ 10K __ 5K

Hoosier Hikers Council Member Rate

______ $10 Pre-registration Donation (No T-shirt)

______ $20 Pre-registration Donation (With T-shirt)

Non-Member Rates

______ $15 Pre-registration Donation (No T-shirt) (Day of race: $20)

______ $25 Pre-registration Donation (With T-shirt) (Day of race: $30)

Family Rate

______ $25 Pre-registration Donation (T-shirts $10 each extra)

Check T-shirt Size: __ M __ L __ XL __XXL

______ $20 Hoosier Hikers Council membership*

______ TOTAL

WAIVER: In consideration of your acceptance of my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Indiana Track Club, the Hoosier Hikers Council, the Indiana Department of Natural Resources, the Counties of Morgan and Monroe, all sponsors and their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities.

Signature_____________________________________________
                                                Parent or Guardian if under 18

Entry fee must accompany entry. Make checks payable to Hoosier Hikers Council. Mail to: HHC, P.O. Box 1327, Martinsville, IN 46151

*The Hoosier Hikers Council is a fully tax deductible 501 (c) 3 non-profit organization.