2019  ELLERBE   MARATHON  MAILABLE  ENTRY   FORM
                         Mailed entries must be post marked no later than February 1

                    
PLEASE GO TO OUR WEBSITE AND READ THE COMPLETE INFORMATION AND        
UPDATES FOR THE ELLERBE MARATHON BEFORE SUBMITTING YOUR ENTRY
DOUG DAWKINS, Race Director   910-206 2095 call or text    E-Mail  doug@theboogieraces.com

SCHEDULE OF EVENTS
Friday, February 22
5:00-7:00 p.m.                            Packet pick-up at the Spring House
Saturday, February 23
6:30-7:30 a.m.                            Race day registration and packet pick-up at       
                                                Ellerbe Rescue Squad Building
7:45 a.m.                                    Pre-race briefing at the start line
8:00 a.m.                                    Start of marathon and half marathon
10:00 a.m.                                  Lunch begins at the Rescue Squad Building

                                   
       
This entry is for the  _____Marathon          ______Half Marathon

Entry fees are the same:        $60 entry postmarked before January 1
for both events:                      $75 entry postmarked January 1 through February 1
                                                Paper mail-in entry closes February 1.

Send completed entry and check to:  Ellerbe Marathon P.O. Box 96 Ellerbe, N.C.  28338
                          
Name (please print)______________________________________________________________

Email_____________________________________Phone__________________________________________

Address________________________________________City_________________State________Zip_________

Sex________Date of Birth____________Age Race Day________

Do you live in Richmond County, N.C.?_______

Shirt size (circle one)    S      M       L       XL       XXL

Ellerbe Marathons completed________Ellerbe Half Marathons completed________

Emergency contact___________________________________________Phone_____________________

Waiver and release:   I understand and agree in consideration of being permitted to participate that
me (the participant), my heirs, personal representatives or assigns of me do hereby release, waive,
discharge and covenant not to sue the Race Director, Assistant Director, Wilson Timing, any of its
owners, officers, representatives, any and all event directors or coordinators, The Ellerbe Rescue
Squad or any of its members, any and all event volunteers or USA Track and Field from any and all
liability from any and all claims arising from participation in the Ellerbe Marathon or the Ellerbe Half
Marathon.  I realize that participating in a marathon is a sometimes risky and potentially hazardous
endeavor and assume all responsibilities for my participation.  I certify that I am properly trained and
medically able to participate in this event.  I realize that the race director has the right to refuse any
entry and that decisions rendered by the race director whether in participation or finish results will be
final. My signature below verifies that I have read all pertinent entry information and this waiver and
agree to abide by all rules and guidelines presented in the entry information and also to accept any
changes or decisions rendered by the race director before or during the event.

Participant Signature____________________________________________________Date__________

Parent's Signature if participant under 18_________________________________________________