Run The Burg
sponsored by
Ear, Nose and Throat / Plastic Surgery of Warrensburg

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Registration
 

                                                 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.

Half Marathon - $45

10K                 - $35

5K                   - $25




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 $45____
                                            10K $35____
                                              5K $25____

T-shirt size (XS-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 

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