HTRJ 2009 - Registration

Click here to register online
If you would prefer to mail in your application, complete the entire form below, print the form, sign the waiver, enclose a check payable to Hit The Road Jack, and mail to the address below. Please include a self-addressed stamped 4”x10” envelope.

Fee: $20/adults, $15/age 16 and under if postmarked by May 21, 2009. $25/$20 thereafter or on Race day. Sign up for one (1) Race only:

	Sex Date of Birth Age
Last Name
First Name
Address
City
State		Zip Code	Ph #

Check One

10K Run/Walk

2.2M
Run/Walk

Wheel Chair

E-Mail Address

WAIVER RELEASE FORM
In consideration of your accepting this entry, I, the undersigned, intending to be legally bound, hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Hit The Road Jack Wine & Cheese Country Run, their representatives, successors, and assigns, for any and all injuries suffered by me in said event. I attest and verify that I am physically fit and do hereby grant the sponsors permission to use my likeness participating in this event without obligation to me. As part of this release and waiver I acknowledge that I have read and understand all of the above.

__________________________________________
Runner’s Signature
(If under 18 parent/guardian must sign)

_______________
Date

Hit The Road Jack!
P.O. Box 1857
Sonoma, California 95476

HIT THE ROAD JACK!
Wine & Cheese Country Run
10K/2.2M
Run/Walk

June 7, 2009
8:00 a.m.
Sonoma Plaza