FREDERICKTOWN TOMATO SHOW
5 MILE RUN ENTRY FORM

The Tomato Show 5 MILE RUN will be held on Saturday, September 11, at 9:00 a.m.
The race route will be the same as last year. The start will be at the Fredericktown Elementary School. Water will be available at two places along the race course. Locker rooms and showers are available at the starting point at Fredericktown Elementary School, 111 Stadium Drive.

Pre-registration before September 3 will be $11.00. The fee on the day of the race will be $15.00 for all ages. Race day registration begins at 7:30 a.m. at the Elementary School. Make checks or money orders payable to the FREDERICKTOWN TOMATO SHOW. Mail application below and payment to:

Dick Brenneman, P. O. Box 26, Fredericktown, OH 43019.

For more information call Dick Brenneman (740)-694-1755.


Name _________________________________________________________

Age as of 9/01/10______________________ Male/Female_______________

Address_______________________________________________________________

_____________________________________________________________________

Shirt size_________________

In consideration for the foregoing, I, for myself, my executors, administrators, and assigns, do hereby release and discharge the Fredericktown Tomato Show Board of Directors, Fredericktown School District, Village of Fredericktown, and private property owners from claims of damages, demands, action and causes of action whatsoever in any manner arising or growing out of my participation in said run. I have full knowledge of the risks involved and certify that I am physically fit and sufficiently trained to participate in this race.

Signature of parent or guardian (if runner is under 18 years of age). __________________________________

Signature of the runner ______________________________________________

The Tomato Show Board would like to post photos from this year's events on our web site www.tomatoshow.com. We are requesting permission to possibly use your picture on the site. By signing your name here, you are granting permission for a picture of you or your child to be used. I allow my photo or my child's photo to be used on the Tomato Show web site ________________________________

DEADLINE FOR PRE-REGISTRATION IS SEPTEMBER 3.

RACE DAY REGISTRATION BEGINS AT THE ELEMENTARY SCHOOL ON STADIUM DRIVE AT 7:30 A.M.!