7/30/2019 Run Hog Wid Registration Form
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Run Hog Wildat the Cochon de Lait!Saturday, May 11 th, 2013
Registrat ion Fee: $25.00, Please register by April 28th,
2013.(Shirt not guaranteed with late or race day registration. No
refunds.)
Registrat ion/Check- in: 6:45 a.m. in front of Mansura Pavilion,
1832 Leglise StMansura, LA 71350
Race Start Time: 7:30 a.m.Divis ions and Awards:
Male/Female/Youth; 1st 3rdplace in each age division.Refreshments
will be available at finish line for race participants. Runners are
invited to ride on the RUN HOG WILD float the Cochon de Lait Parade
at 10:30. For more information, contact: Alicia Laborde @
318-308-6688 [email protected].
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - -Mail completed form to Mansura Lions Club,
P.O. Box 61, Mansura, LA 71350
Name: ________________________________ Phone:
___________________________Address: _____________________________
Age: ___________________________City:
_________________________________ State:
___________________________Please Circle the fol lowing:Race: 5 K
Run 1 Mile WalkDivis ion: Men Women Youth
16 39 16 39 5 15
40 + 40 +
T-shirt Size: S M L XL XXL Youth Size: S M L XLExtra t-shirts
may be purchased for $15. Please indicate size(s) and quantity
above and include with registration fee.
Waiver : I agree to abide by the rules of this competition as
stated above, and I understand that decisions of the event
officials are final. I knothat running/walking a race is a
potentially hazardous activity. I should not enter a race or run
unless I am medically able and properly trained.
assume all risks associated with running/walking in this event
including, but not limited to falls, contact with other
participants, the effects
weather, traffic, and conditions of the road, all such risks
being known and appreciated by me. Having read this, I am entitled
to act on behalf o
waive, and release The Town of Mansura, The Mansura Chamber of
Commerce, The Mansura Lions Club, staff and volunteers of these
agencies, arace officials and directors, associated sponsors, the
Cochon de Lait Committee, their representatives and successors,
from all claims or liabilities
any injuries arising out of my participation in this event. I
grant my permission to all the foregoing to use any photographs,
motion picture
recordings, or any photographic record of this event for any
legitimate purpose:
_________________________________________________
___________________________________________
Signature of participant or parent/guardian if under 18 Date
