RACE APPLICATION

RUN FOR BARB

Raising Awareness of Domestic Violence

Sunday - May 11, 2008

NAME __________________________________________________________________

AGE ________      SEX ________

ADDRESS ____________________________________________

CITY ______________________________ STATE ______ ZIP CODE ________________

EMAIL ADDRESS ______________________________________________

DAYTIME PHONE NUMBER _____________________________________

 

MAKE CHECKS PAYABLE TO:

SEND CHECK AND APPLICATION TO:

Sorry No Refunds ----- Rain or Shine. Please complete entire form and sign release. One person per entry. Please copy for additional entries. All pre-registered runners and walkers guaranteed a T-Shirt. Race day registration T-Shirts available while they last. Please note it is not necessary to collect pledges in order to participate. Run for Barb is a 501 (c) (3) non-profit organization dedicated to raising awareness of domestic violence. All proceeds from this race will benefit the Run for Barb's identified charities.

RELEASE
In consideration of your accepting my registration for the Run for Barb, I intending to be legally bound for myself, my heirs, executors and administrators, do hereby release and discharge any and all organizations and sponsors from any and all liablility from illness, injury and damage I may suffer as a result of participating in the Run for Barb. I have read the entry form and all information contained within the event brochure provided and certify compliance by my signature. I also agree that my entry fees, once paid, are non-refundable. I have read and agreed to the terms of the waiver on this form. No baby joggers, baby strollers, animals on leash, skateboards or skates.
 
Signature _____________________________________________________
 
Date ____________________________________
 
Parent/Guardian Signature ________________________________________