5K Walk/Run Registration

Date*

Participant Information

Name*

First Last

Date of Birth*

Age on Race Day*

Gender*

Male
Female

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Race/Walk Information

Race Choice*

5K Run
5K Walk

Adult 5K T-Shirt*

Release and Waiver

I, the undersigned, in consideration of the acceptance of the entry and registration as participant in the Mules & Blues Fest 5k waive and any all claims which I and my heirs and assigns may now have or hereafter have against the City of Marks or the County of Quitman, its members, and all officials, volunteers of the Mules & Blues Fest 5k which may directly or indirectly result from my participation in the 5k. I further warrant and represent that I am in proper physical condition to participate in the 5k and am not participating in this event against physicians’ advice nor am I taking medication which would impair my health or ability to participate in this event. I further understand and agree that bicycles, strollers, skateboards, skates and the like are prohibited in this event and I will abide by these restrictions.

Entry Fee per Person*

Price:

Quantity*

Total

$0.00

Participant's Signature*

I agree
I do not agree

(Parent/Guardian must sign if participant is under 18)

Name

This field is for validation purposes and should be left unchanged.

5th Annual Mules & Blues Fest

Participant Information

Race/Walk Information

Release and Waiver