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Light
Up the Night 5K/1M
Entry Form
In honor of Jennings Osborne
December 8, 2012 --
5:00pm --
River Market, Little Rock, AR |
Name:
Last:
First: |
Date of Birth:
Sex: M F
Age on 12/8/2012: |
Address: |
City, State, Zip: |
Phone:
Email: |
Shirt Size: S
M 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
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Fees: $20 pre-registered, $25 day of race
Pre-registration/packet pick-up at Easy Runner, Friday,
December 7 from 10:00am to 6:00pm
Race day registration 3:30pm to 4:45pm
For information or
directions to course, 501-231-3730,
bjtorrey@sbcglobal.net
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