HAPPY TAILS 5K Run/Walk
Friday , June 20, 2008
7:30 p.m.
Start: Blue River Memorial Park
1021 E. Morris Avenue
Shelbyville, IN 46176
MAIL IN REGISTRATIONS DUE BY June 11, 2008
PRINT, FILL OUT AND MAIL TO:
Energy2Action, LLC
227 W. Mechanic Street
Shelbyville, IN 46176
Name:
Address:
Address:
City:
State:
Phone:
E-mail:
Age on Race Day:
T-shirt?
Size:
Zip:
Male
Female
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, organizers, City of Shelbyville, Shelby County Animal Shelter, 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 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. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Are you running with a dog?
Name of dog?
Total Enclosed
