5k color fun run entry form

Saturday April 27, 2013

 

Pre-register by: March 15, 2013

Time: 5K 9:00 am           1 Mile Run/Walk 10:00 am

2013 Stomping Out Cancer One Step at a Time

 

5K Color Run — 1 Mile Color Run/Walk

Registration Form

 

 

Name:______________________________________________________

 

Address:____________________________________________________

 

City:______________________State______________Zip_____________

 

Phone:_________________  Email_______________________________

Used for updates on the race

Date of birth:___________________  Age:_______  Sex        M         F

Race    5K           1 Mile         Virtual run               Shirt size:   S     M     L    XL     2X    3X

Entry fees:

5K – $20.00 or 1 Mile Run/Walk – $15.00  (5K runners may do the 1 Mile run/walk for free)

Virtual Runners $20.00 – shirt will be mailed for free.

Preregistered runners will be guaranteed a t-shirt

Late fee: $5.00 each event

Late: – race day registration runners – will start at 8:00 am

*SWTFR members deduct $2.00

_____My Payment is enclosed.  (Make checks payable to: Relayers Who Care Relay For Life Team)

Mail Registration form to: Denise Mohlman*Box 944*Lakin, Ks 67860*phone 620-271-8339

Email: denise.mohlman@gmail.com

ONE ENTRY PER APPLICATION *THIS MAY BE REPRODUCED *NO REFUNDS, EXCHANGES OR TRANSFERS

Every Participant Must Sign This Waver!  Parent/Guardian for anyone under 18 must sign the waver.

I know that running/walking a road race is a potentially hazardous activity.  I should not enter unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the event.  I assume all risks associated with this event including, but not limited to falls, contact with other participants, the effects of weather, traffic and conditions of the road, all such risks being known and appreciated by me.  Having read this wavier and knowing these facts and in consideration of you accepting my entry, I, for myself and anyone entitled to act on my behalf; waive and release the Relayers Who Care Relay For Life Team, and all volunteers associated with this event from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

 

Signature_______________________________Date__________________________

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