Poplar Golf Course







 

 

 

Poplar Golf Course
Fall Fest
September 10th, 2011
9:00 AM - 2:00 PM

This will be a rain or shine event!

5K Cross Country Race Registration Form

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After submitting your registration, you'll be taken to
the PayPal Payment page automatically!

All Fields are Required

Name:  
Address:  
City:  
State:  
Zip:  
Phone:   (###-###-####)
Email:  
Age on
Race Day:
 

Birthdate:

(MM/DD/YY)
Shirt Size: Small Medium Large XL XXL


Release of Liability

By checking this box, I acknowledge the following release of liability statement. 
This check mark will be considered my valid signature in agreement of the release of liability statement below:

I agree that if I participate in this physical activity, program or event or use any event facility or event premises, I do so at my own risk.  I agree that I am voluntarily participating in the event and using the event facilities or premises and assume all risks of injury, illness, damage, or loss to me or my property that might result including, without limitation, any loss or theft of personal property.

By checking the box above, I intend to be legally bound hereby, for myself, my heirs, and administrators, waive and release any and all rights and claims for damages against Poplar Golf Course and its representatives, successors, and assignees for any and all injuries suffered by me that may occur before, during, and after my participation in this event on September 10, 2011.  Furthermore, by checking the box above I verify that I am physically fit and have sufficiently trained to fully participate in this event.

 



Poplar Golf Course • (715) 364-2689 • Cell: (218) 391-9073
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Arranged & Designed by Agape Mobile Management Systems, Inc (715) 392-6940