Run The Burg
sponsored by
Ear, Nose and Throat / Plastic Surgery of Warrensburg
Run The Burg Registration Form
You may print this page and mail it to: Run The Burg
706 Burkarth Rd.
Warrensburg, MO. 64093
Registration can be done online at www.active.com or in person at Ear, Nose and Throat / Plastic Surgery of Warrensburg at 706 Burkarth, Warrensburg, MO 64093. Office phone number 660-747-5444. Registration is nonrefundable.
Go to the link below to directly access the registration site:
https://www.active.com/event_detail.cfm?event_id=2039235
Half Marathon - $40
10K - $30
5K - $20
There may be a $10 late entry fee charged for all registrations done within 1 week of the race.
First Name: _________________
Last Name: _________________
Address: ___________________
___________________
City: ______________________
State: _____________________
Zip: _______________________
email: _____________________
phone: _____________________
Date of Birth: ________________
Age on race day: _____________
Sex (M/F): _________________
Event entering: 1/2 marathon $40____
10K $30____
5K $20____
T-shirt size (S-XXL): __________
Waiver: I know that running is a potentially hazardous activity. I will not enter this race unless I am medically able to properly train for this event. I assume any and all risks associated with this event both controlled and uncontrollable. I authorize any use of photography associated with this event of which can be used for any purpose.
Signature:_________________________ Date: __________
If paying by credit card (Visa, MC, Am. Ex, Discover): #_________________________________exp: ___________
Signature:_____________________________
Make all checks payable to: Run The Burg