2021  ELLERBE   MARATHON  MAILABLE  ENTRY   FORM
                                             Race day February 27, 2021                 
  
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

                                             
This entry is for the  _____Marathon          ______Half Marathon

Entry fees are: $65 entry postmarked by December 31, 2020
                      $75 entry postmarked January 1, 2021 and after

Make check payable to "Doug Dawkins"
Send completed entry and check to:           Doug Dawkins
                                                                        129 Springer Mountain Road
                                                                        Rockingham, N.C.  28379               
                                      
       
                                              
                       
Name (please print)_______________________________________________________________
__
Email______________________________________________Phone________________________

Address_________________________________________________________________________

City_______________________________________________State___________Zip____________

Sex________Date of Birth______________Age Race Day________

Do you live in Richmond County, N.C.?  yes___no___       Mangum Track Club member?   yes___ no___

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, and
discharge 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, and any and all event volunteers of all liability from any and all claims arising from my
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_________________________________________________