(print this page and mail it with your registration fee to:
John Trigg Ester Library, attn: Readers on the Run, PO Box 468, Ester, AK 99725)

OR drop the completed form & payment off at Beaver Sports, the Ester post office bulletin board, the Golden Eagle Saloon, Gold Hill, or the John Trigg Ester Library. (Please put in an envelope addressed to Readers on the Run)

Race to be held Sunday, October 9, 2011

Registration fees & shirts:

before October 7, without -t-shirt: $10
before October 7, with t-shirt: $20

October 7-9, without t-shirt: $15
October 7-9, with t-shirt: $25

additional t-shirts or for nonparticipants: $15

shirts are still available in the 2008, 2009, and 2010 designs, $10 at race (shortsleeved) or $15 (longsleeved)

Participant information:

Name:

Mailing Address:

phone number:

e-mail:

Age on race day:

Age class (circle one): 9-15 - - - 16-20 - - - 21-35 - - - 36-50 - -- - 51-69 - - - 70+

t-shirt size: S --- M --- L --- XL --- XXL (youth / adult)

I will be soliciting sponsors for this race (circle one)(see pledge form): yes / no

Bib # will be assigned at check-in. Please pick up your packet, with bib, at check-in, starting 10 am at race start point--library gazebo on Village Road, Ester, Alaska)

NOTE: Risk waiver must be signed and dated before entry can be processed.

Parent/guardian must sign for entrants under 18

By signing below, I accept and agree to the following conditions:

Running is an action sport with hazards and risks which can cause me severe injury or death. In consideration for my participation in this event, I understand and accept the responsibility for these risks, conditions, and hazards. I hereby release and waive any claim I may have against the organizations and people conducting this event--the John Trigg Ester Library and the Friends of the Ester Library--for any injury, including death, which may come to myself (or my child) as a result in this event, including as a result of negligence of any person or entity.

Participant Signature:________________________________________

Date:___________________

Parent Signature:____________________________________________

Date:___________________

4th Annual Readers on the Run poetry fun run, 11 am, Sunday, October 9, 2011

Contact: Ed Rouleau, 458-9550, or Nancy Burnham, 457-6667

(below to be filled out by JTEL; entrant please leave blank)

ENTRY#

AMT PAID

BIB#

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