The First National Bank of Montana Summit Classic 5K Entry Form
Sunday, April 20, 2008
The Summit Fitness Center, Kalispell, MT
WEBSITE: www.summithealthcenter.com
CONTACT: Krista Schaefer, (406) 751-4133, kschaefer@krmc.org

Official Use Only

Instructions
> Type in your information in the blanks provided.
> Print entry form & SIGN WAIVER (Entry will not be accepted without the signed waiver)
> Make Checks Payable to:
The SUMMIT Classic 5K

Mail to:
The Summit Fitness Center
205 Sunnyview Ln
Kalispell, MT 59901


Event - Choose One (T-shirt included in entry):



SPECIAL FAMILY RATE (please fill out an entry for each person indicating which event they are participating in - then submit the entries with the special fee.)

COMPANY RATE (Must be 10 or more) Please fill out an entry for each person - then submit the entries together with the special fee.)

First Name / MI / Last Name

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy (birth year not 2008)

Age

Gender

Phone

Email

Division (Individuals)

T-Shirt Size

Check#

Amount Enclosed



WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I know that participating in an organized athletic event is potentially hazardous, and that I should not enter to participate unless I am medically able and properly trained. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am physically fit and that I have sufficiently trained. I agree to abide by the competitive rules. I hereby take the following action for myself, my executors, administrators, heirs, next to kin, successors and assigns, or anyone else who might claim or sue on my behalf, and I hereby waive, release and discharge from any and all claims, losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bills, or theft which may arise out of or relate to my participation in this event. I agree not to sue, and to hold harmless any and all persons, sponsors, volunteers, participants or government agencies for any and all claims or liabilities that I have waived, released or discharges herein. I also agree to return the ChampionChip timing devise assigned to me or to pay a $30 replacement fee. I understand that the Entry Fees are Non-Refundable/Non-Transferable.

Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________