IMPORTANT:

All information on this page MUST be completed to be pre-registered.

You may complete this registration for and mail your form/check to the address below or register online with a credit card at Active.com
(Please type or print) Entire form must be completed.

Name_______________________________________________________Phone(     )_______________

                    (last)                                 (first)

Address_______________________________City____________________State_________Zip________

Age_______Sex:     M     F     T-Shirt Size:     S     M     L     XL     XXL

EVENTS (MUST CIRCLE ONE)

2-Mile Fun Run

2-Mile Walk

2-Mile Junior

4-Mile Main Event
Waiver/Release:  I hereby certify that I am adequately trained and physically fit to participate in this run and further that I fully understand the strenuous nature of this event in consideration of the acceptance of this entry.  I, the undersigned, for myself, my personal representative, beneficiaries and heirs, knowingly waive, release and forever discharge any and all rights and claims which I may have or may hereafter accrue to me or my estate against the race directors, officials or volunteers or other sponsors, groups of individuals, their agents, representatives, successors, and assigns for any and all injuries or death suffered by me in this event or for damage to or loss of personal property.  I also give my permission for the free use of my name and picture in broadcast, telecast, video tapes, or other news or publicity account of the event.

Signature:_______________________________________________Date:________________________

(Signed by parent or guardian if under age 18)
Entry Fee:  All events pre-registration $14.00.  Postmarked after 24th $18.00

Entry Fee Submitted $_______________

In celebration of the 26th Anniversary of the Karen Lawrence Run, please accept my additional donation of $25.00 or more.

Additional Donation for St. Jude Hospital$_________

(Tax Deductible)

Make checks payable to:

St. Jude Children's Research Hospital

and mail to:

Steve Rogers

P.O. Box 5599

Chattanooga, TN 37406

Divisions

Main Event

2-Mile Jr. (15 & under)

4-Mile

Age Groups (Female)

Open & Masters

1st & 2nd Place

24 & Under, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-69, 70 & Over

Age Groups (Male)

Open & Masters

1st & 2nd Place

24 & Under, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-69, 70 & Over