Cobden Runners'/Walkers' Club
Please complete in full the application below, make checks payable to the Cobden Runners'/Walkers' Club, and return application with payment to:
Cobden Runners'/Walkers' Club
Proceeds will be donated to Cobden service organizations.
Cut application below this line and send
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Event T-shirts are
only guaranteed for pre-registered entrants:
Name: ________________________________________
First MI Last
Address: ______________________________________
City: _________________________________________
State: ______________________ Zip: ______________
Telephone: (_________) _________________________
Age on race day: _______________ Sex: ___________
Please circle the appropriate response below:
Event: 5K Run 5K Walk 1 Mile Fun Run
T-shirt size: Adult: M L XL XXL
Child: S M L
ALL WALKERS MUST WALK ONLY!
(This will be enforced! Any walker who runs will be disqualified!)
Waiver and release
This liability waiver is to be signed by all entrants, or by parent or guardian, if entrant is under 17. In consideration of your acceptance of this entry, I, intending to be legally bound, hereby, for myself, my heirs, executors and administrators, waive and
Your donations are welcome. The Cobden Runners'/Walkers' Club is a non-profit organization and all donations are tax deductible.
For more information, please call:
(618) 893-4050 or (618) 893-2148 (and leave a message on the answering machine), or e-mail jlsheets@earthlink.net or visit http://rrr.olm.net on the web and click on calendar.
with payment to the address shown above.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
release, the Village of Cobden, the Cobden Runners'/Walkers' Club, the Cobden Lions Club, and any and all sponsors and their representatives, successors, and assigns from any and all rights and claims for damages I may have arising out of or any injuries and illnesses suffered by me in this event, including those which may be attributable to weather conditions. I attest and verify that I will participate in this event as a footrace entrant, that I am physically fit and have sufficiently trained for the completion of this event and a licensed medical doctor has verified my physical condition. Further, I hereby grant full permission to any and all of the publicity and/or promotional purposes without obligation or liability to me.
I have read the entry
information provided and certify my compliance by my signature below. I understand entry fees I pay are
non-refundable.
SIGNATURE: ___________________________
PARENT/GUARDIAN: ___________________
(If applicant is under 17 years of age.)
|
This space reserved for Run/Walk Committee: Date Rec _______ Amt _______ Initial _____ |
v2, 4-21-05