Name ______________________________ Age on race day __________ DOB __________ Sex ________
Address __________________________City _____________________ State ______ Zip ______________
Phone _________________________________ T-shirt size M L XL (Please circle one)
Marathon ________________________ 14.2 MILER _____________________
In an emergency contact _________________________________________________________________
Email _________________________________________________________________________________
WAIVER
In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against the officials or the sponsors of the Tupelo Marathon for injury or illness which may directly or indirectly result from my participation in this event.
SIGNATURE _______________________________________________ DATE _____________________
(Parent if under 18 years of age)
Marathon
$50 through August 1st
$60 after August 1st
14.2 Miler
$40 through August 1st
$50 after August 1st
Mail Entries To
Checks Payable To:
Mike Lail
Attn: Tupelo Marathon Director
2411 Crestwood Drive
Tupelo, MS 38801
