OFFICIAL REGISTRATION FORM - 5K for the 3Day
Saturday, May 12, 2012
Name ______________________________________________
Address__________________________________________
City___________________________ State_______ Zip___________ Age________ Sex___
Phone #_________________________ email_______________________________________
Shirt Size: M_____ L_____XL_____ (Register by April 21st to guarantee a t-shirt)
RELEASE: In consideration of the acceptance of my entry, I, the undersigned intending to be legally bound myself, my heirs, executors, and administrators, do hereby release any and all sponsors, directors, and volunteers of this event, the 5K for the 3Day 2012 and their representatives, successors and assigns from any and all liability from illness or injury I may suffer as a result from my participation in this event. I attest and verify that I am physically fit and properly trained for the competition of this event. I assume all risks associated with but not limited to falls, contact with other participants, the effects of the weather, traffic, temperature and course conditions. I also understand that fees are not refundable.
Signature_________________________________________________ Date________________
(Participant's signature is required - Parent's signature required for minors)
Registration $20.00 ($25 race day) $_______________
Donation to 3Day Walk $_______________
Total Enclosed $_______________
Make Checks payable to 3 Day Walk c/o Amy Mastin
Mail Check and Entry to:
Amy
Mastin
register at www.5kfor3day.org
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