Print Registration

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Note changes:

No shirt with late entries and no entries will be accepted after May 22nd.

Print and complete form.

Return by 5:00 PM May 22nd to:

Fresh Air Experience
Ten Mile Entries
311 Victoria Ave. E.
Thunder Bay, Ontario
P7C 1A4
(807) 623-9393

(mail or drop off available at this location)

Confederation College Fitness Centre

(drop off only available at this location)


NAME:
ADDRESS
POSTAL / ZIP CODE
PHONE NO.
EMAIL ADDRESS
SEX
BIRTHDATE
TEAM / CLUB NAME
AGE AS OF May 18
FIREFIGHTER DIVISION
T-SHIRT SIZE		XS S M L XL (please circle size)
NO SHIRT OPTION

FEES
ENTRY		$35.00 (BY MAY 12th)
NO SHIRT		$20.00 (BY MAY 12th)


Late Entry:
ENTRY		$40.00 ( MAY 13th - 16th)
ATTENDING DINNER?		Y N (PLEASE CIRCLE ONE)
DINNER GUESTS		# @ $10.00 each

TOTAL

		* Cheque Payable to:TEN MILE ROAD RACE

In consideration of Thunder Bay Professional Firefighters Association, the City of Thunder Bay and members of the organizing committee and all other volunteers and sponsors accepting my entry, I hereby, for myself, my heirs, executors, administrators and assignees, waive and release Thunder Bay Professional Firefighters Association, the City of Thunder Bay and their members and employees and members of the organizing committee and all other race volunteers of all claims and responsibility for damages, injuries and loss of articles which I may sustain as a participant in the Ten Mile Road Race. I acknowledge and understand all risks associated with this event and attest to be sufficiently trained to participate. I have read and fully understand this release/waiver.

Signature:

Gaurdian Signature
		(must be signed by parent or gaurdian if under 19)

Thunder Bay Professional Fire fighters Association