29th Annual Smokey Bear Fun Run
Entry Form

Fee: $15.00 early registration until June 24 (items will be available at race)
$20.00 late registration, June 25 – July 4 at 7:15AM (items will be mailed)
Race Day Registration until 7:15AM July 4, 2009
Mail completed entry form and Check or Money Order payable to:
Smokey Bear’s Hometown Association, P.O. Box 223, Capitan NM, 88316
Or drop off at the Smokey Bear Historical Park at 118 Smokey Bear Blvd. Capitan, NM

Please Check:
___ Male ___ Female
___ 10K Fun Run ___ 2-mile Fun Run

Please type or print                                                                                                                   Age as of July 4th 2009 ______
Name: _______________________________________________________________________ Address:______________________________________________________________________ City:___________________________________ State: ______________ Zip: _______________ Home Phone: _____________ Work Phone: _____________ E-Mail______________________

Entry fee includes one of the following items, please check one:
___ T-Shirt: (Check One Adult Size): __ S __ M __ L __ XL __ XXL
___ Hat (embroidered with “Smokey Bear Fun Run, 29th Annual, Capitan NM”
___ 2 Bandannas (24 inches square, with t-shirt image in one corner)
Additional items may be obtained by contacting the race director

RELEASE OF LIABILITY – (Must be signed) Please read carefully before signing.
In consideration of your acceptance of this entry, by my signature below I intend to legally bind myself, my heirs, executors and administrators, I waive and release any and all rights and claims for damages I may have against the Village of Capitan and the organizers of the 29th Annual Smokey Bear Fun Run, for any and all injuries sustained and suffered by me during this event. I also understand that in the event this race cannot be held as scheduled due to an act of nature or circumstance beyond the organizers’ control, my entry fee is non-refundable. IN CASE OF INJURY OR INABILITY TO FINISH THE RACE, I HEREBY GRANT THE EVENT ORGANIZERS PERMISSION TO TRANSPORT ME/MY CHILD TO THE NEAREST AID STATION OR MEDICAL FACILITY. Further, I hereby grant full permission to use any photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purpose. I understand that the entry fee is NON-REFUNDABLE, and that race numbers are non-transferable. I have read the above and understand that by signing below I am releasing the organizers as stated above.

Signature of Entrant __________________________________ Date ________

Signature of Parent or Guardian _________________________ Date ________
(If entrant is under the age of 18)