Eagle Endurance Challenge II: September 7, 2024

Location: 15605 Long Run Road, Laurelville, OH 43135
Race Date: Saturday, September 7, 2024
Time: Starting times from 9:00AM to 12:00PM

Full Name*

First NameLast Name

Age*

Date of Birth

Date

Email*

example@example.com

Phone Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Person

First NameLast Name

Emergency Person Phone Number

Area CodePhone Number

Relationship to Emergency Contact Person

T-shirt Size*

Have you run the EEC before?

YesNo

How did you hear about the Eagle Endurance Challenge?*

Are you running the race for time?*

YesNo

Registration Fee

Eagle Endurance Challenge - ALL PARTICIPANTS$75.00

Payment due at registration, the morning of the event. Cash or check only, thank you!

Quantity

Total $0.00

I confirm that I am in good shape, health, and condition.I don't have any medical conditions or medical history that will affect my participation in this event.I will follow the rules and regulations of the event.I acknowledge that this race requires physical activity and there are possible risks and danger.I release the event organizers for any responsibility in case of an accident, illness, or injury.I agree to sign a full release the day of the event.I allow my photo to be taken during the event and used for event advertising and marketing.I confirm that all information in this registration form is accurate and true.

Participant's Signature*

Date Signed*

Date

Parent/Guardian Signature (If participant is below 18 years old)

Date Signed

Date

Eagle Endurance Challenge: September 7,2024!

Participant Details

Registration Payments

Waiver & Release