Outhouse Run Registration 2013

Outhouse Run Registration Form

Name & Phone______________________________________________________________________

Name & Phone______________________________________________________________________

Name & Phone_______________________________________________________________________

Name & Phone_______________________________________________________________________

All participants agree that their safety is their responsibility and that the Whitley Chamber of Commerce, Columbia City Street Department, and Whitley Arts Partnership are not responsible for any accidents or injuries. This is a fun community event—please make sure you are adequately insured!

Please sign acknowledging that all participants understand this safety statement and all race rules:

_________________________________________   _______________________________________

_________________________________________   _______________________________________

Date _________________________

REGISTRATION FEE:

$25.00 PER TEAM.           

Please return this form to Whitley Chamber of Commerce and write “Outhouse Run” on the memo line of your check. The Chamber is now located next to Orizon Real Estate behind Arby’s and Maria’s.