nnie's Ca

 W12505 Roosevelt Road

Gresham, Wisconsin 54128


Soggy Bottom 5K

Soggy Bottom 5K Run/Walk Registration Form

 Registration by June 15th only $25.  June 16th to July 8th and at the door - $30.00

First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Evening Phone:
Check one: Runner  Walker
Adult Short Size: Sm. M. Lg.X-Lg.XX-Lg. (Add $2)

By June 15th - $25.00,  June 16th to July 8th and at the door - $30.00

Make checks payable to: Tilleda Advancement Assoc.

Mail to: Charlotte Schwartz
W11946 Maple Ridge Road
Gresham, WI  54128
Release Waver: I know that participating in a run/walk is a potentially hazardous activity of which I fully assume all risk of injury, illness or death. By my signature, I certify that I am medically able to perform this event, am in good health, and am properly trained. I agree to abide by any decision of an official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with running in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, insects, traffic and other course conditions all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Town of Seneca, the Tilleda Advancement Club, Annie’s Campground and all volunteers, sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Disclaimer: By pressing the Submit Button, I declare that I am a participant over 18 years of age / or the parent or guardian of a minor child participating in the event.

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