HERO HUSTLE 5K Run/Walk
Saturday, June 8, 2019
6:00 p.m.
Start:  Riverfront Taproom
530 N. Harrison St.
Shelbyville, IN  46176


MAIL IN REGISTRATIONS DUE BY June 2, 2019
$30.00 5K Run/Walk With Short Sleeve T-shirt
$25.00 5K Run/Walk No T-shirt

PRINT, FILL OUT AND MAIL TO:
Energy2Action, LLC
1223 Oak Lane 
Shelbyville, IN  46176


Name:
Address:
Address:
City:
State:
Phone:
E-mail:
Zip:
Male 
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Signature: 
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, Riverfront Taproom, Helping Hand for Freedom, and  Energy2Action, LLC, 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 or all  sections of this run  course might 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.
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Make Checks Payable to:  Energy2Action, LLC
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$30.00 5K Run/Walk With Short Sleeve T-Shirt
$25.00 5K Run/Walk No T-shirt
$________Extra Donation To Helping Hands For Freedom
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