MAD DASH
OFFICIAL ENTRY FORM 
2012 PRICES COMING SOON!!

Registration: Saturday, September 8th at 8:00 a.m.
Mad Dash begins at 9:00 a.m. on Main Street in downtown Okarche 

Name _____________________ Phone __________

Address ____________________________________________

Event     ___  1 Mile Walk/Run    ___ 5K Walk/Run

Make checks payable to: OEF (Okarche Educational Foundation)

Registration Fee: $        (12 yrs. & under)
                         $        (over 12 yrs.)

                          Add: $2.00 for XXL shirt
                                 $3.00 for 3XL or 4XL shirt

      ____Youth XS ____ Youth S   ____ Youth M  ____ Youth L

      ____Adult S    ____ Adult M   ____ Adult L    ____ Adult XL

      ____Adult XXL   ____Adult 3XL    ____Adult 4XL  

Amount Enclosed  _______       ____Check     ____Cash

Mail entry form and registration fee to: OEF, PO Box 324, Okarche, OK  73762

Waiver/Release:  In consideration of acceptance of this entry, I waive any & all claims for myself and my heirs against officials and sponsors of the Okarchefest Mad Dash for illness or injury which may result directly from my participation in this event.  I also grant permission for my name and likeness to be used in photographs, video recordings or any other record of this event for any legitimate purpose in supporting the Okarchefest Mad Dash.

Signature __________________________  Date _________
(Parent’s signature if under 18)

*Registration fee includes a t-shirt and a commemorative medallion.  Race day entrants will be given t-shirts/medallions until supplies are exhausted.

IF USING THIS FORM FOR MULTIPLE ENTRIES, PLEASE LIST THE INDIVIDUAL NAMES OF ALL PARTICIPANTS BELOW.