Printable Registration Form
Please fill out completely and neatly. Please provide one form for each entrant.
First Name: _____________________________ Last Name: ________________________________
Gender: ______________ Age on Race Day:____________ Date of Birth:_____________________
Email Address: __________________________________________________________
Phone #: _______________________ Emergency Contact # for Race Day: _______________________
Street Address: ______________________________________________________________________
Please Circle your Choice Below Students under 19 years are 1/2 Price
Select Race: Lake Martin 100 Mile After Jan 31 $ 220 After Feb 1 $ 240
Lake Martin 50 Mile After Jan 31 $ 100 After Feb 1 $ 110
Lake Martin 27 Mile After Jan 31 $ 55 After Feb 1 $ 65
The Tech Shirts below are available in addition to the Performance Blend you will receive with your race registration.
* Endurance Tech Shirt Short Sleeve $ 22 Long Sleeve $28 $_______
Please Circle Size: Men's - S M L XL XXL Women's - S M L XL
* Very nice color fast shrink resistant 100% Cotton Hoodie $ 28 $_______
Please Circle Size: S M L XL XXL
. * See image of Tech Shirts and Hoodie Below
Enter the total of the entry fee and additional items: $ ___________
Performance Blend short sleeve shirt included with entry - Shirt Size (circle one): S M L XL XXL
Parents of runners under 19 in the 100 must contact the RD before registering.
The race committee may decline to accept any application for entry for any reason.
BY SIGNING THIS RELEASE 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. In consideration of your accepting my entry, and intending to be legally bound for myself, my heirs, my executor, and my administrators, I hereby release and discharge the Lake Martin 100, Southeastern Trail Runs, LLC, the Race Committee, organizers, sponsors, Russell Lands, Russell Crossroads, Russell Forest Trail Association, Inc. and each and every person and entity affiliated and associated with the lake Martin 100 and Southeastern Trail Runs, LLC from any and all liability, rights and claims for damages I may have arising out of my participation in this event, and waive all rights I may have to any such claims. I attest that I am physically fit and have sufficient training for the completion of this event and that a licensed medical doctor has verified my condition. I acknowledge that the course is strenuous and is run on difficult terrain on back-country trails and on paved and unpaved roads in conditions that can change without notice at any time. I acknowledge that there are inherent risks associated with my participation in this event, and agree to pay all of my own medical and emergency expenses in the event of accident, illness or other incapacitation regardless of whether I have authorized such expenses at the time they are incurred. I also grant full permission to the race organizers and sponsors to use any photographs or other records of my participation in this event for any legitimate purpose. I further understand that participating in a trail race is a potentially hazardous activity. I will not enter and run or walk unless I am medically able to do so and properly trained. I assume all risks associated with running or walking this event, including but not limited to the effects of weather, traffic, course conditions and course surfaces, falls, and contact with other runners, volunteers and spectators. I am aware that medical support for this event will be provided by volunteer personnel or professional medical personnel who may be called upon to provide assistance, including first aid, to me during or after the event. I authorize any such volunteer or professional to assist me or to perform such assistance as in the opinion of such person may be necessary or appropriate. This application must be signed. Applicants under 18 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. I consent to the use of photographs, video, film and sound recordings of all race events for all legitimate purposes. I give permission to be contacted by interested media. I further understand that the Lake Martin 100 is a trail race and that I will be exposed to hazards and obstacles not normally associated with road races. These hazards include, but are not limited to, exposed rocks and roots in and on the trail, tree branches and limbs on and near the trail, irregularities in the trail surface, uneven transitions from one surface to another and wet or slick surfaces. All these hazards and obstacles pose a significant risk of falls that can result is possible serious injury. Some trails are very technical and pose a risk of falls down steep slopes in very remote areas where rescue may be difficult. IN THE EVENT THAT A RUNNER REQUIRES EMERGENCY EVACUATION BY GROUND or HELICOPTER-AMBULANCE, THE RUNNER ASSUMES ALL FINANCIAL OBLIGATIONS CONNECTED WITH THIS SERVICE. Race management is NOT responsible for any debt incurred. Race officials reserve the right, at their discretion, to disqualify and remove from the course, any person who is knowingly or unknowingly violating any rules or instructions issued by said officials or by their action or actions are create an unsafe situation on the course. I understand that the entry fee is non-refundable and non-transferable. I have read the waver provided and certify my compliance by signature below. This release is a Release of Liability Waiver.Printable
SIGNATURE ___________________________________________________ Date____________________
Unsigned entries will not be accepted. Parents must sign for children under 19-years-old.
Signature of Parent are guardian if entrant is under 19: ____________________________ Date ___________