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Malvern Brickfest 5K
Entry Form
Saturday, June 24, 2000 — 7:30 a.m. |
Name: |
Address: |
City, State, Zip: |
Birthdate:
Age on 06/24/00: |
Shirt Size: S M L XL
Sex: M F |
Division: Runner
Walker
Wheelchair |
Release:
I know that racing is a potentially hazardous activity and I should not enter and run in this race 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 run. I assume all risks associated with running and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Malvern Runners, Race Chairman, the City of Malvern, the County of Hot Spring, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or club activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. |
Signature:
Date: |
Parent Signature if under 18 years:
Date: |
Make checks payable to Malvern Runners and mail to:
Malvern Runners
9 Country Oaks
Malvern, AR 72104
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Fees: Early registration: $12
Race day: $15 (Registration begins 6 a.m.)
T-shirts are guaranteed to the first 275 preregistered (others will be mailed)
MORE INFO: jrucker@hsnp.com
caveman@hsnp.com
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