Qdoba DINO Trail Run Series Entry Form 2010

WHICH DATE(S) ARE YOU REGISTERING FOR? ____

DISTANCE: 5k___ 15k___

AGE: _____ SEX: M__ F__

LAST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

FIRST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

HAVE YOU ENTERED A DINO RUN IN THE PAST YEAR? No Yes – if yes you may leave lines below blank, unless changed.

STREET ADDRESS: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

CITY: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| STATE: |__|__|

ZIP: |__|__|__|__|__| PHONE#: (____)|__|__|__-__|__|__|__|

E-MAIL: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

T-SHIRT, SINGLET, HAT, or SOCKS (additional fee – see below) SIZE: S___ M___ L___ XL___

OPTIONAL:

TEAM/SPONSOR: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: _____________________________

Total Paid: ____

EVENT# / DATE / CITY / VENUE

1. March 13 Indianapolis, IN Eagle Creek Park

2. March 27 Anderson, IN: Mounds State Park

3. April 10 Avon, IN Washington Twp Park

4. June 5 Nashville, IN: Brown County State Park

5. Aug 28 Indianapolis, IN Town Run Trail

6. Oct 9 Indianapolis, IN SouthWestway Park

7. Nov 13 Indianapolis, IN: Ft Harrison State Park

PRICES per event

Note: online entry is the same price, with no additional fees: www.DINOseries.com/run

ITEM	Early*		Day-of	Season Pass
5k	$13		$15	$85
15k	$18		$20	$115
T-Shirt	Add $10			included
Singlet		(Pyro Apparel DINO Singlet) - $25
Headsweats Hat		$10
DeFeet Socks		(Air-e-ator DINO Logo) - $5 (Woolie Boolie DINO Logo) $10

*Early Registration must be received by the Wednesday before the event.

ALL RUNNERS MUST SIGN A LIABILITY RELEASE FORM AT THE RACE VENUE.

Mail entry with check payable to: DINO LLC, PO Box 36395, Indianapolis IN 46236

For the most complete and updated information: www.DINOseries.com/run

DINO Hotline (317)336-7553 e-mail Brian10@DINOseries.com