----------
Dino Dash 5K
May 31, 2008 --
5K, 8:00am; 1K, 9:00am -- Little Rock, AR |
Name:
Last:
First: |
Date of Birth:
Sex: M F
Age on 5/31/08: |
Address: |
City, State, Zip: |
Shirt Size: Adult
-- S
M L
XL XXL(+$2)
Youth --
S M L |
Division: 5K
Run/Walk 1K Fun
Run |
Phone:
Email: |
Team Name (if applicable):
Captain: |
Release:
I know that running and volunteering to work in club races are
potentially hazardous activities. 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 Dino Dash 5K, the Museum of Discovery, the
City of Little Rock, ArkansasRunner.Com 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: |
Form of payment (Circle One):
Check Visa Mastercard |
Credit Card Number:
Exp. Date: |
|
Make checks payable to The Museum of Discovery and mail to:
MOD/Dino Dash, 500 President Clinton Avenue, Ste. 150, Little Rock, AR 72201
|
Fees:
$15 per person Teams of
5 or more (mail together, due by
5/3/08)
$20 individual pre-registration by 5/3/08
$25 everyone after 5/3/08 and race day registration
For
information, call 501-396-7050 ext. 214 or email
jforrest@amod.org |
|
.gif)
