ArkansasRunner.com


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Light Up the Night 5K/1M
Entry Form
In honor of Jennings Osborne
December 14
, 2013 -- 5:00pm -- River Market, Little Rock, AR
Name:
Last:                                                                             First:

Date of Birth:                             Sex:      M     F             Age on 12/14/2013:

Address:

City, State, Zip:

Phone:                                       Email:

Shirt Size:     S            L        XL         XXL        YM        YL                       

Circle One:          5K Run          1 Mile

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 Light Up the Night 5K, the City of Little Rock, the County of Pulaski, 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:


Make checks payable to Light Up the Night 5K and mail to:
Light Up the Night
3515 Old Cantrell Road
Little Rock, AR  72202


Fees:  $20 pre-registered, $25 day of race
Pre-registration/packet pick-up at Rock City Running, Friday, December 13 from 10:00am to 6:00pm
Race day registration 3:30pm to 4:30pm

For information or directions to course, 501-231-3730, bjtorrey@sbcglobal.net