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Last Name                                        First Name                                                           MI

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Street Address or P.O. Box No

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City                                                                        State                                                      Zip

___________________                           ___________________        __________

Date of Birth                                               Age on Race Day                Sex

Circle Event            10K               2K

Circle T-Shirt size                  YM             YL             S             M             L             XL             XXL

Are you a wheelchair entry?   Yes____  No____

Registration Fee 2K: 

$10 now until Race Day

Registration Fee 10K:

$16.00 prior to April 30, 2007

$18.00 prior to May 11, 2007

$20.00 Race Day - May 12, 2007

Make checks payable to:

TUPELO RUNNING CLUB

10k Best Last 12 Months ____________________________________________

                                              Minutes                 Seconds

Drug Testing

Athletes who participate in this competition may be subject to formal drug testing in accordance with USATF rules and IAAF Rule 144. Athletes found positive for banned substances, or who refuse to be tested, will be disqualified from this event and will lose eligibility for future competitions. Some prescriptions and over-the-counter medications contain banned substances. Information regarding drugs and drug testing may be obtained by called the USOC Drug Hotline at 1-800-233-0393.

Waiver: In consideration of acceptance of this entry, I waive any and all claims for myself and my heirs against officials or sponsors of the 2007 Gum Tree Run for injury or illness which may directly or indirectly result from my participation. I further state that I am in proper physical condition to participate in this event.

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Runner's Signature                                                                                     Date

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Parent or Guardian if Under 18

(No Refund of Registration Fees)

Mail To:

Tupelo Running Club

Gum Tree Run

P.O. Box 511

Tupelo, MS 38802

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Race Number