Dolphin Dash - Gertrude Check

I
Dolphin Dash
This is A Captain's Cup Event
5KAND 10K RUNS, 1 MILERUN/WALK
I
April 11, 2015
Naval Base Kitsap Bangor
Starting Time and Place
Saturday April 11, 2015
_ 9:00 a.m.-9:45 a.m.
Registration and number pickup in Bldg. 2700 (the gym)
Cost and Registration
_ Prior to April 9th
$15.00 donation, no shirt
$40.00 Immediate Family entries received together.
(no shirts)
_10:00A.M.
5K starts at 1000 in front of gym
1 Mile and 10K start 5 minutes after 5K
_ Pre-registration required by April S'" for
runners requiring base access
_ 10K course is hilly
5K course is moderately hilly
_ April 9th & later
$18.00 each donation, no shirt
_ Shirts
Shirts are long sleeve unique Submarine design.
Cost $10.00 Shirts not guaranteed for race-day registrations.
Proceeds benefit the Bremerton Base, Submarine Veterans Scholarship Program
Entry Form (please print)
Complete and mail this entry form with your non-refundable check or money order payable to USSVI Bremerton Base
Mail Entries to Bremerton Subvets, PO Box 465, Silverdale, WA 98383-0465
M
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Name: -:First
Phone
_
(Include area code)
------,:=---------
M.I.
Last
Ad~e~:~_~~~_:_~~~~~~~~~_:_~~~~~----~-~~~-~
Street Address
City
Age on April 12th
DOH
Command
(Active Duty)
/
__~Zip
State
Race Event: 10K
/
5K
__ Forbaseacce~p~aseprovide
Last 4 digits of SSN
_
Y@s,I need base access~~~_
IMile run/walk
_
E-mml.~
--
$1J':00 donation prior to April 9th, $1$00 each thereafter, ($g&00) Family Pre-registered (no shirt)
Shirts $10.00, Shirt size S
I Mile
5 K run
10 K run
8 & under
13 & under
18 & under
9 to 13
14-18
19-29
Race Liability
Release:
in consideration
forever waive, release and discharge
of your
14 to 18
19-29
30-39
19 & over
30-39
40-49
40-49
50-59
directors,
said
officers, employees
expenses,
50-59
~70plus
expenses
and that I am physically
X
and assigns,
and claims for damages and causes of suit or action known or unknown,
Bremerton
Base,
and any and all participating
race sponsors and supporters
of the risks involved
in the event of accident,
fit and sufficiently
with this race. I understand
that
and the
in
in this race, that I assume those risks, that I will assume and pay my
illness or other incapacity,
trained to participate
regardless
of whether 1 have authorized
in this race. I grant permission
entry fees are non-refundable.
~70plus
Signature
Signature of parent or guardian if under 18 years of age
SUGh
to any and all the foregoing
60-69
my likeness in connection
60 -69
Veterans,
L
and agents of such parties for any and all injuries in any manner arising or resulting from my participation
race. I attest and verify that I have full knowledge
own medical and emergency
acceptance of this race entry, I myself, my heirs, executors, administrators
any and all rights, demands,
I may have against the United States Submarine
M
Date
Date
to use