2018 Entry Form 03 11 18 .pdf
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Original filename: 2018 Entry Form - 03-11-18.pdf
Title: 2018 Entry Form
Author: Kent 05-2014
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ENTRY FORM
DATE:
Saturday, May 5, 2018
TIME:
Registration 7:30a / Race at 9:00a
LOCATION:
Alcoa High School / Springbrook Park
ENTRY FEE:
$20 per person | $10 for students | $0 for sponsors
INFORMATION: Contact Chris Brewster at 865-684-1660 (charles.brewster@cornerstoneofrecovery.com)
or Kent Stephens at 865-660-9463 (kent@wivk.com)
Participant Name:
Group Name:
Address:
City, State and Zip:
Telephone:
Age on Race Day:
Gender:
T-Shirt Size:
Male
Female
Youth: S M L XL | Adult: S M L XL XXL
DISCLAIMER: My signature confirms that, as a participant in the Cornerstone Race for Recovery, I agree to hold harmless
Cornerstone of Recovery, Inc., Cornerstone of Recovery Alumni Association, Cokesbury United Methodist Church and
Susannah’s House in the event of any injury that results from my participation in this event.
Signature of Participant:
Date:
Signature of parent of legal
guardian if participant is
less than 18 years of age:
Date:
Email or fax this form to:
Kent Stephens
kstephens@agaii.com
865-717-6638 (Fax)
Mail to: Chris Brewster
Cornerstone of Recovery
1214 Topside Road
Louisville, TN 37777
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