Badge of Honor Benefit Run 2017

Registration Form

Event Details: Saturday, April 1, 2017 9:00 A.M.

Three Rivers College 2080 Three Rivers Blvd. (Bess Activity Center) Poplar Bluff, MO 63901

Choose a Race / Registration / 5K
Strollers allowed,
10 and under accompanied by an *adult / 10K
10 and under accompanied by an *adult / Half Marathon
12 and under accom panied by an *adult
Early Registration to September 30, 2016 / $ 25.00 / $ 35.00 / $ 50.00
October 2, 2016 to November 30, 2016 / $ 30.00 / $ 40.00 / $ 60.00
December 1, 2016 to April 1, 2017
(to guarantee participation awards, applications must be completed by March 1, 2017) / $ 40.00 / $ 50.00 / $ 70.00

Name (Last Name, First Name) ______

Address: ______

City, State Zip: ______

Age (On 4/2/2017) ______

Gender: Male ______Female ______5K_____ 10K_____ Half Marathon _____

Phone Number: ______

E-mail: ______

All sections must be completed on the Registration and Waiver form in full. One participant per form.

(*Adult = 18 or older)

All proceeds raised go to the BOHR Inc. for disbursement.

Badge of Honor Benefit Run 2017

Waiver Form

I understand that participating in the event can be a hazardous injury activity, presenting risk. For consideration of participation in the event, I freely accept and voluntarily assume the risks of personal injury or property damage that may result. I and anyone entitled to act on my behalf, waive and release from all claims and liability of any kind arising out of my participation, even though that liability may arise out of negligence or carelessness on my part. I agree to hold harmless the Badge of Honor Benefit Run Inc, organizers, sponsors, official, or any other coordination group or member associated with this event, from any liability as a result of my participation. I understand that officials with the Badge of Honor Benefit Run Inc. withholds the right to dismiss anyone that may cause disturbance. I certify that I have read and understand the intent of this waiver and release. There will be no refunds if the event is cancelled due to weather.

Is runner 18 and over: YES ______NO ______AGE ______

Signature (18 and over)______Date ______Parent/Guardian (runner under18 years of age) ______Date ______


T-shirt Size: XS ____ SM ____ Med _____ Lg ____ Xlg ____ XXLg ____ XXXlg _____ / Adult _____ Youth _____

All participants registered by March 1, 2017 deadline will be guaranteed a shirt and medal. We will have extra shirts and medals on hand for those registering after the deadline, but will be distributed to participants in the order they are received, while supplies last.

Payment Information: Registration Fee: $ ______

Cash, Check, or Donation : $ ______

Money Order

Total: $ ______

Make payable to Badge of Honor Benefit Run Inc.

For race packet pick-up information, visit our website: www. bohbr.com.

Return forms and fees to:

Badge of Honor Benefit Run Inc.

PO Box 648

Poplar Bluff MO 63902

Mailed registration forms must be postmarked by the registration deadline as appeared on the registration form. (e. g. 11/1/2016; 1/1/2017)

You can late register on the day of the event but are not guaranteed a shirt or participation award.