Printable Registration Form for the 2019 Southeastern Trail Series Races Mail to: David Tosch - STR
Please fill out completely and neatly and provide one form for each individual 220 Normandy Ln.
Chelsea, AL 35043
First Name:_____________________________ Last Name:______________________________ Gender: M - F
Age on Race Day:_______ Date of Birth: ___________ Email Address: _______________________________________
City/State/Zip:_________________________________________________________ Phone # ___________________
Emergency Contact Name: ________________________________________ Phone # _________________________
Short and Long series runners may choose to run the Blood Rock 50 or 100 mile. Points available are limited to 16 Pts - Short Series, 32 Pts Long Series.
2018 Southeastern Trail Runs Races:
March 23 & 24, 2019 Lake Martin 100 27 Mile - $75.00 50 Mile - $110.00 100 Mile - $220.00 (Lake Martin is Open)
The following 6 Races are points races in the Southeastern Trail Series: The first series races and Registration for the "Full 2019 Series" open Dec 1st.
Select Race / Races for the 2018 Southeastern Trail Series: Short Race Long Race
April 13th - Tranquility Lake Trail Race 3 Mile - $35.00 6 Mile - $40.00
May 4th - Run for Kids Challenge 10K - $40.00 12 Hour $110.00 50K - $90.00 (Proceeds to Camp Smile-A-Mile)
May 25 - Memorial Day Weekend Trail Race 6 Mile - $40.00 12 Mile - $50.00 (No charge to active military)
July 13th - Hotter 'N Hell Trail Race 9 Mile - $50.00 18 Mile - $65.00
August 24th - Ridge to Blazing Ridge 10.5 Mile - $50.00 21 Mile - $65.00
Nov 23rd - Blood Rock 25K & 50K 25K - $60.00 50K - $90.00
The Blood Rock 50 and 100 Mile can be run as part of the Southeastern Trail Series Points Championship but points will be awarded as if you ran the 25 or 50K.
The following races are NOT Points Races in the 2019 Southeastern Trail Series. (Registration on the races below open March 1st)
October 19th - 21st - Endless Mile 6 Hour - $50.00 12 Hour - $85.00 24 Hour - $120.00 48 Hour $200.00
October 27th - BOO Run for Down Syndrome Alabama 10K - $35 5K - $30 1 Mile Fun Run $10 (Proceeds to Down syndrome Alabama)
(Fun Run is free to all Down syndrome individuals)
Nov 23rd & 24th - Blood Rock 50 Mile & 100 Mile 50 Mile - $110.00 100 Mile - $220.00
Please select your shirt size here: S M L XL XXL
Total of all entry fees for selected races: $ _____________
High School Runners or 18 & under, Registration fee is 50% off standard fee: $ - _____________
Active Duty Military Discount - 25%, Retired Military and Reserves - 10% Discount $- _____________ (Memorial Day no charge)
Enter Club Discount Code (________________) Enter Discount Amount $-_____________
Make Check Payable to: Southeastern Trail Runs Total Enclosed $ _____________
WAIVER In consideration of the foregoing, I, for myself, my heirs, executors, administrators, personal representatives, successors and assigns, waive and release any and all rights, claims and courses of action I have or may have against Southeastern Trail Runs or any Southeastern Trail Runs Event, including but not limited to, Lake Martin 100, 50 & 27, Run for Kids Challenge, Smile-A-Mile, Tranquility Trial Race, Memorial Day Trail Race, Hotter 'N Hell Trail Race, Ridge to Blazing Ridge Trail Race, Birmingham Stage Race, Endless Mile Race, BOO Run for Down Syndrome Alabama, Blood Rock 25 & 50K Trail Race and Blood Rock 50 and 100 Mile Trail Race, David Tosch, Marye Jo Tosch, The City of Pelham, Oak Mountain State Park, USATF, Sponsors, race volunteers or their agents, employees, officers, directors, successors and assigns, and any and all sponsors, their representatives and successors, that may arise as a result of my participation in any of the afore mentioned Southeastern Trail Runs events, and any pre- and post- event activities. I understand that this event may cause serious bodily harm including broken bones and even death. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I also understand that this is a USA Track and Field Sanctioned event and all USATF rules and regulations govern this event. For and in consideration of USA Track & Field, Inc. (“USA Track & Field”) allowing me, the undersigned, to participate in the USA Track & Field sanctioned event described above (the “Event” or “Events”); I, for myself, and on behalf of my spouse, children, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns, hereby agree to and make the following contractual representations pursuant to this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement (the “Agreement”); 1. I hereby represent that (i) I am at least eighteen (18) years of age or older; (ii) I am in good health and in proper physical condition to participate in the Event; and (iii) I am not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my ability to safely participate in the Event. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Event, that I am responsible for my own safety and well-being at all times and under all circumstances while at the Event site. 2. I understand and acknowledge that participation in track & field, road running, race walking, cross country, mountain, ultra, and trail running Events is inherently dangerous and represents an extreme test of a person’s physical and mental limits. I understand and acknowledge the risks and dangers associated with participation in the Event and sport of track & field and related activities, including without limitation, the potential for serious bodily injury, sickness and disease, permanent disability, paralysis and loss of life; loss of or damage to equipment/property; exposure to extreme conditions and circumstances; contact with other participants, spectators, animals or other natural or manmade objects; dangers arising from adverse weather conditions; imperfect course or track conditions; land, water and surface hazards; equipment failure; inadequate safety measures; participants of varying skill levels; situations beyond the immediate control of the Event Organizers; and other undefined, not readily foreseeable and presently unknown risks and dangers (“Risks”). I understand that these Risks may be caused in whole or in part by my own actions or inactions, the actions or inactions of others participating in the Event, or the negligent acts or omissions of the Released Parties defined below, and I hereby expressly assume all such Risks and responsibility for any damages, liabilities, losses or expenses which I incur as a result of my participation in any Event. 3. I agree to be familiar with and to abide by the Rules and Regulations established for the Event, including but not limited to the Competitive Rules adopted by USA Track & Field and any safety regulations established for the benefit of all participants. I accept sole responsibility for my own conduct and actions while participating in the Event, and the condition and adequacy of my equipment. 4. I hereby Release, Waive and Covenant Not to Sue, and further agree to Indemnify, Defend and Hold Harmless the following parties: USA Track & Field, Inc., its members, member clubs, associations, sport disciplines, the Event Directors, Organizers and Promoters, Sponsors, Advertisers, Coaches and Officials; the Host Organization and the Facility, Venue and Property Owners or Operators upon which the Event takes place; Law Enforcement Agencies and other Public Entities providing support for the Event; and each of their respective parent, subsidiary and affiliated companies, officers, directors, partners, shareholders, members, agents, employees and volunteers (Individually and Collectively, the “Released Parties” or “Event Organizers”), with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss or expense (including court costs and reasonable attorney’s fees) of any kind or nature (“Liability”) which may arise out of, result from, or relate in any way to my participation in the Event, including claims for Liability caused in whole or in part by the negligent acts or omissions of the Released Parties. I further agree that if, despite this Agreement, I, or anyone on my behalf, makes a claim for Liability against any of the Released Parties, I will indemnify, defend and hold harmless each of the Released Parties from any such Liabilities which any may be incurred as the result of such claim. I hereby warrant that I am of legal age and competent to enter into this Agreement, that I have read this Agreement carefully, understand its terms and conditions, acknowledge that I will be giving up substantial legal rights by signing it (including the rights of my spouse, children, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns), acknowledge that I have signed this Agreement without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Agreement. This Agreement represents the complete understanding between the parties regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions. Further, I hereby grant full permission to any and all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose including commercial advertising. I agree to all conditions listed above.
I have read, understood, and accept all terms and conditions of the above agreement. By initialing this agreement I certify I have read this waiver _______ (initial)
Applicants under 19 years of age must have the signature of a parent or guardian approving such entry. The race committee may decline to accept any application for entry for any reason.
Please Print Name:
SIGNATURE OF PARENT OR LEGAL GUARDIAN IF ENTRANT IS UNDER 19:
PRINT NAME OF PARENT OR LEGAL GUARDIAN IF ENTRANT IS UNDER 19:
Unsigned entries will not be accepted. Parents or Guardian must sign for children under 19-years-old.
BY SIGNING THIS FORM YOU GIVE UP ANY CLAIM FOR INJURY OF ANY KIND AND CERTIFY YOU HAVE READ THIS WAIVER AND THAT YOU AGREE TO IT'S TERMS PRINTED ABOVE. LIABILITY RELEASE: ________________________________________________