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Register by July 1st to avoid a late fee! Runner’s Stampede 1402 Heart Mountain St PO Box 2200 Cody, Wyoming 82414 IMPORTANT INFORMATION: A late-registration fee of $10.00 ($40.00 total) is due for all entries received or postmarked after July 1st Incomplete entries or entries submitted with insufficient funds will not be processed. THE REC CENTER WILL BE CLOSED JULY 4TH RESULTS AND PRIZES WILL BE AVAILABLE AFTER NOON JULY 5TH A $30 fee will be assessed for returned checks. How to Enter Please complete the attached registration form. Make checks payable to the City of Cody. In-Person: City of Cody Parks, Recreation & Public Facilities Department 1402 Heart Mountain Street Cody, Wyoming 82414 (307) 587-0400 Mail (postmarked by July 1st for early entry) Send completed entry form & payment to: RUNNER’S STAMPEDE PO BOX 2200 CODY WY 82414-2200 DO NOT SEND CASH Pre-Registration: Preregister by July 1st & save $10! Late Entries: $40 Early Entry Fee: $30.00 30th Cody Runner’s Stampede July 4th 2012 5K Walk 5K Run 10K Run Early Entry Fee Includes a Performance Sport–Tek T-shirt and refreshments ---PAGE BREAK--- 10K (6.2 miles) Race day registrations CLOSE at 6:45 a.m. $10.00 Late fees apply T-shirts NOT guaranteed Wednesday - July 4, 2012 Race begins at 7:00 AM 5K Walk A fun and healthy way to start the 4th of July! Prizes will be given to the first place men and women finishers overall. 5K and 10K Run Prizes will be given to the first place men and women finishers in each age group Events 2012 Runner’s Stampede Entry Form 1. Check the race you are entering Only one entry per application, please. 5K Walk 5K Run 10K Run 2. Division Check gender and age group. Male Female 13 & under (5K only) 14-19 20-29 30-39 40-49 50-59 60 + 3. T-Shirt Size T-Shirt sizes are not guaranteed for late entries. Small__ Medium__ Large__ X-Large__ XX-Large__ 4. Name and Contact Information Full Name Address City State Zip Phone 5. Terms of Participation Please read this information carefully, and let us know if you have any questions or concerns. The Cody Parks & Recreation Department does not provide medical insurance to cover participants during an activity. This is the responsibility of each individual involved in any department program or activity. I hereby give my consent for myself (or for a minor of which I am a legal guardian) to participate in recreational activities sponsored by the Cody Parks & Recreation Department in Cody, Wyoming during any session of the recreation program. I hereby release the Shoshone Recreation District, Recreation Director, Recreation Staff and Board of Directors, the Cody Parks & Recreation Department, the City of Cody, Olive Glenn Golf Course and all City staff associated therewith from all liability, including claims and suits at law or in equity for any injury fatal or otherwise, while participating in any of the recreation activities and understand that I will be fully responsible for any damage or injuries incurred by the participant while involved in any Recreation Department activity. Also, I hereby pledge to provide positive support, care and encouragement for my fellow competitors and league officials by following this Code of Ethics. I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at every game. I will treat other players, coaches, fans and officials with respect regardless of race, sex, creed or ability. I understand that I am participating in a recreation activity and agree not to use profane language or engage in “trash talking” at any time. I will lead, by example, in demonstrating fair play and sportsmanship to all my fellow competitors. I understand that the officials are there for my benefit and will agree not to direct any profane or threatening actions toward them (either verbal or physical). I understand that any violation of this code shall be cause for the Shoshone Recreation Board and Cody Parks & Recreation, in executive session, to deal with any behavior and/or conduct that is considered by the Board to be disruptive, destructive, and/or illegal. Behavioral problems may result in expulsion from the program without reimbursements. Participant Signature (Parent/Guardian Signature if Participant is a Minor) 5K (3.1 miles) Course Pick up race packets at the Paul Stock Aquatic & Recreation Center parking lot between 6:00 and 6:45 AM. SIGN