|Step 1 of 2 - Participant Registration|
|Address 1||Address 2|
|State / Province|
Use 2 digit code for US and Canada
otherwise, leave blank.
|Country, if outside of the U.S. and Canada|
Leave blank if address is in US or Canada.
|Zip / Postal Code|
|Primary Phone Number|
Required... please provide your primary number.
Optional... Provide an alternate phone number.
Your active Email Address... check for accuracy.
|Participant's Date of Birth|
M for Male, F for Female.
SALOMON DISCOVERY FZ MIDLAYER Jackets
Fit True to Size.
We cannot guarantee jacket sizes after 3/15/14, as all jackets will be ordered at that time and sent to the printer.
|Emergency Contact Name||Emergency Contact Phone Number|
|Required... provide the name and phone number of someone who is not running in the race as a contact, which we may use in the unlikely event of an emergency.|
Pre-race Pasta Dinner
Optional... We're pleased to offer our pre-race Pasta Dinner to runners, family members, friends and crew. Dinners are available at $10 per person. Enter a number of the dinners that you would like to reserve.
I know that running a trail race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of race officials relative to my ability to safely complete the run. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, becoming lost, injuries or illness from animals or plants, the effects of weather and all risks associated with event participation. Agree to waiver by checking here.
Having read this waiver and knowing these facts and in consideration of you accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the State of Indiana and all race officials and agents, all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. Athletes who do not follow course rules, general good sportsmanship or race day guidelines put forth by the race director's will face potential disqualification and loss of eligibility for future events.
* I represent and warrant that I am in good health and in proper physical condition to safely participate in the event. I certify that I have no known or knowable physical or mental conditions that would affect my ability to safely participate in the event, or that would result in my participation creating a risk of danger to myself or to others.
* I represent and warrant that I am in full command of my faculties and am not under the influence of alcohol or drugs.
* I agree not to participate in the event while under the influence of alcohol and/or drugs.
* I acknowledge that the Indiana Trail 100 recommends and encourages each participant to get medical clearance from his/her personal physician prior to participation.
* I assert that I have not been advised or cautioned against participating by a medical practitioner.
* I understand that it my responsibility to continuously monitor my own physical and mental condition during the event, and I agree to withdraw immediately and notify appropriate personnel if at any point my continued participation would create a risk of danger to myself or to others.
By agreeing to this waiver you submit to the terms and conditions as set forth by this event and certify that you have provided true and accurate information as requested through this registration process.
Do you have a coupon or promo code? If so, please include it here.