TEXAS MARATHON

Please mail completed application to:
Mark Roseland, 4818 River Hill Drive, Kingwood, TX 77345
email: texasmarathonkingwood@gmail.com

Name _____________________________________                    Male / Female

Address ___________________________________                    Shirt size S / M / L / XL / XXL / XXXL

City, State, Zip _______________________________                   # of marathons ______

Marathon or Half Marathon  (circle one)

Is this your first marathon (26.2 miles)?     Y / N     Active Duty Military?  Y / N  Branch_______________                   

Member of the 50 States Marathon Club?    Y / N   Member of Marathon Maniacs of Half Fanatics? Y / N                             

Phone (day) ________________ night ________________          Age on race day _____

Email address ___________________________________           Birthdate ___________

Name you would like on your bib (12 characters or less) ________________________________________________

Emergency Contact Name ________________________________________________ Phone ________________

Fees:   $90                                                                                                                                                             $ ________

Donation to Knights of Columbus Charities                                                                                                          $ ________
                                                                                                                                   
Make check payable to: Texas Marathon                                                                   Total Enclosed                  $ ________

Waiver Must Be Signed

Waiver: All participants in the Texas Marathon assume all risk of participation in the marathon by signing the release agreement.  I the undersigned athlete on behalf of myself and on behalf of my heirs, my executors, my administrators and my trustees, waive and release any and all rights and claims for any loss(es), injuries and damages including, but not limited to demands or actions for negligence, premises liability, emotional injury, intentional conduct, tort claims, and any other actions or demands of whatever nature, I have or may have against 1) The Texas Marathon, 2) its officials, agents and representatives, 3) all sponsors of the event in which I may participate whether my participation is as a contestant or as a spectator.  I acknowledge that I am aware of the inherent risks involved in this event and I voluntarily assume the risks.  I attest and verify that I am physically fit and I have sufficiently trained for the competition of the above-mentioned event in which I participate.  I hereby grant full permission to any and all of the foregoing to use my name, and/or my picture in any account of this event for any purpose whatsoever.  I have read the entry information provided for the event and certify my compliance by signing below.  Athlete acknowledges that the entry fee is non-refundable and non-transferable.

Signature of athlete_______________________________ Date ___________

* Signature of parent/guardian ______________________ Date ___________

*(if athlete is under 18) I certify that my son/daughter has my permission to compete in the Texas Marathon, is in good physical condition and that race officials have my permission to authorize emergency care if necessary.