9th Annual
Panguitch Valley Balloon Rally Run
5K Entry Form
Or Register at Active.com
Sat., June 24h, 2017 ∙ 7:00 AM ∙ Panguitch High School Track, 390 E 100 S
Entry Fee: $20
The race starts at the Panguitch High School track, runs through town and loops back to the high school as a mass of hot air balloons soar overhead. With cool summer temperatures and the mountains of Southern Utah as a backdrop this is a truly unique 5K run/walk.
Name: _____________________________________ Age on Race Day:___________
(LAST) (FIRST) (M.I)
Address: ____________________________________ Gender: Male Female
City: _________________ State: _____ Zip Code: ___________
Phone Number: (_____)-_____-_________ T-Shirt Size: SM M LG XL
E-mail: _________________________________
Legal waiver for entry. In consideration of your accepting this entry for the Panguitch Valley Balloon Rally 5K Run, I the undersigned intending to be legally bound hereby, for myself, my heirs, executors and administrators, waive and release any and all right and claims for damages I may have against race officials, volunteers, sponsors and their representatives, successors, assigns, for any and all injuries suffered by me in this event. I attest and verify that I am physically fit and am able to participate in this event. Further, I hereby grant full permission to the above named to use any photographs, videotapes, motion pictures, recordings or any other record of this event for any legitimate purpose. Race officials’ decisions are final.
________________________________________ _____________
Signature (Parent or Guardian if under 18) Date
Race day registration: 6:00 am to 6:45 am @ Panguitch High School, 390 E 100 S
Race day registrants are not guaranteed a t-shirt.
Contacts: Anne Anderson (616-5060), Danny Yardley (676-2240)
Please Make Checks Payable to: Panguitch Cross Country
PHX
Please Mail Entries To:
Panguitch Cross Country
PO Box 566 ∙ Panguitch, UT 84759