Registration

2012 Johnnycake Jog Entry Form. YOU MUST PAY ON-LINE WHEN USING THIS FORM!!

The fields marked with (*) are required fields.

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Which race are you entering?

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Male or Female

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Age

* required

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What is your age division?

*

What size shirt would you like?

*

Last Name

* required

*

First Name

* required

*

Address

* required

*

City

* required

*

State

*

Zip Code

* required

*

Phone Number

* required

E-mail address

Phone number of Emergency contact

*

I have read the release statement below

*

I understand that this registration is not complete until I continue to the Payment Page and SEND CREDIT CARD PAYMENT

You are encouraged to pick up you race packets July 12th and 13th at The News-Herald 7085 Mentor Avenue. Willoughby, Ohio from Noon to 7 P.M.

Release:
In consideration of the acceptance of my entry, I for myself,my executors,administrators, and assignees... do hereby release and discharge The News-Herald/Lake Health, the Lake County Fair,the townships of Concord and Painesville, the cities of Mentor and Painesville and other sponsors of all claims and damages,demands,actions whatsoever in any manner arising out of my participation in said athletic event. I attest and verify I have full knowledge of the risks involved in this event and I am physically fit and sufficiently trained to participate in this event. I understand the race officials reserve the right to disqualify and remove any entrant from the race whom they deem as a potential hazard to themselves and others.

The Johnnycake Jog

Registration