Name:
Address:
Address:
City:
State:
Phone:
E-mail:
Zip:
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of Shelbyville, Shelby County Athletic Club,  Energy2Action, LLC, and The Shelby Roadrunners,  for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event.  I understand and acknowledge that participating in this run/walk  event may expose me to dangers from both known and anticipated risks.  I understand that the course is not closed to traffic and that I could be at risk from traffic, other runners and cyclists, bad weather, ice and rough terrain along the course.  I acknowledge that some sections of this run  course may be off road or rough road and may contain areas where I will  be at risk of tripping and falling.  I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor.  I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason.   Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.





Age on Race Day:
"BURN IT OFF"

Friday, November 24, 2017
5K Run/Walk - 9:00 a.m.
Start:  Intelliplex Conference Center
2150 Intelliplex Dr.
   Shelbyville, IN  46176
(I-74 and State Rd. 9 - a short drive from Indy)

Pre-registration is due by 11/20/17!
$20.00 
(A FREE gift is included with each registration!)




All credit card payments are received on line through Pay Pal, a reputable and secure payment center. No entity or individual is given access to your credit card  information other than Pay Pal  - not even Energy2Action.  Please note that there is a $1 fee for processing through PayPal.
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