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Entry Form
Full, Half, 5K, and Kids' Run First Name: Last Name: Address: City: State: Zip: Phone: E-mail: Date of Birth: Age: Minimum age of 16 for full marathon. Sex: Male Female Other Info: Wheelchair Entry First Marathon T-Shirt Size Small Medium Large XLarge 2XL Mark Your Race: Full Marathon (Early Bird - $60; After 7/31 - $70; Race Day* - $80) Half Marathon (Early Bird - $40; After 7/31 - $50; Race Day* - $60) 5K Run ($20) Kids' Run (Two canned goods for West Texas Food Bank) Mark Your Attraction Selections: Post-race Luncheon ($10 each) Expo (no charge) Donation for Encounter, Special Olympics Texas, Homeless Coalition WAIVER - ALL PARTICIPANTS MUST COMPLETE In consideration of being permitted to participate in the West Texas CrossRoads Marathon, Half Marathon, 5K Run, or Kids' Run (each referred to as an "Event" or together as the "Events"); and the acceptance of my registration entry, I hereby release, acquit, and discharge CrossRoads Fellowship, the race sponsors, and all their respective directors, officers, employees and agents, acting officially or otherwise (herein referred to as "Releasees") from any and all rights, liability, claims, or causes of action which may occur at any of the Events. For the same consideration stated above, I agree to indemnify save and hold harmless Releasees and each of them from any loss, liability damage or attorney’s fees that they may incur because of the negligence of the Releasees. I attest and verify that I have full knowledge of and accept the risks involved in the Events and that I am physically fit and sufficiently trained to participate in the events for which I am registering. I have read, understand, and voluntarily signed this agreement. Yes, I acknowledge that I have read the waiver above and agree to the terms and conditions as stated. *Race Day Registration 5:45 - 6:30 am All fees are non-refundable and not transferable. A $30.00 fee will be charged to the participant if the timing chip is not returned. **Upon completion of this form, you will be redirected to a secure page where you must submit your total payment via credit card or electronic check.**
Full, Half, 5K, and Kids' Run
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
E-mail:
Date of Birth:
Age:
Minimum age of 16 for full marathon.
Sex:
Male Female
Other Info:
Wheelchair Entry First Marathon
T-Shirt Size
Mark Your Race:
Full Marathon (Early Bird - $60; After 7/31 - $70; Race Day* - $80) Half Marathon (Early Bird - $40; After 7/31 - $50; Race Day* - $60) 5K Run ($20) Kids' Run (Two canned goods for West Texas Food Bank)
Mark Your Attraction Selections:
Post-race Luncheon ($10 each) Expo (no charge) Donation for Encounter, Special Olympics Texas, Homeless Coalition
WAIVER - ALL PARTICIPANTS MUST COMPLETE
In consideration of being permitted to participate in the West Texas CrossRoads Marathon, Half Marathon, 5K Run, or Kids' Run (each referred to as an "Event" or together as the "Events"); and the acceptance of my registration entry, I hereby release, acquit, and discharge CrossRoads Fellowship, the race sponsors, and all their respective directors, officers, employees and agents, acting officially or otherwise (herein referred to as "Releasees") from any and all rights, liability, claims, or causes of action which may occur at any of the Events. For the same consideration stated above, I agree to indemnify save and hold harmless Releasees and each of them from any loss, liability damage or attorney’s fees that they may incur because of the negligence of the Releasees. I attest and verify that I have full knowledge of and accept the risks involved in the Events and that I am physically fit and sufficiently trained to participate in the events for which I am registering. I have read, understand, and voluntarily signed this agreement.
Yes, I acknowledge that I have read the waiver above and agree to the terms and conditions as stated.
*Race Day Registration 5:45 - 6:30 am
All fees are non-refundable and not transferable. A $30.00 fee will be charged to the participant if the timing chip is not returned.
**Upon completion of this form, you will be redirected to a secure page where you must submit your total payment via credit card or electronic check.**
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For general information or sponsorship and booth information call: Matt or Reggie @ 432.352.7944 Jon Willis @ 800.583.6683 Gloria Apolinario @ 432.337.1050
