Running Water For Africa

In consideration of acceptance of this entry, I the undersigned intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against the race director and officials, the City of Milford, MS Running Productions, Uganda Farmers, Incr,HI-TEK Racing, their representatives, any and all race sponsors and supporters, volunteers, their agents, successors and assigns, for any and all injuries suffered by me in said event. I assume all risks with entering this event, including but not limited to falls, contact with other participants, effects of weather, including high heat and humidity, extreme cold or wind, traffic and the condition of the road. All such risks being known and appreciated by me. I attest and verify that I am physically fit and sufficiently trained for the completion of this event. Further, I hereby grant full permission to any and all the foregoing to use my photographs, videotapes, motion pictures, recordings, or any other record of this event for any legitimate purposes without compensation or remuneration. Remeber it is illegal to give your bib, transfer, or take anothers registartion. This will affect our insurance and change the results of the event..

PRINT OUT THIS APPLICATION AND MAIL WITH CHECK


CHECK ONE: 5K Run/Walk________ Kids Fun Run ________

EMAIL: _______________________________________________________ (REQUIRED)
Please print your email so that we can contact you with information, changes, cancellations and esults. Thank you!

LAST NAME:___________________________________________ FIRST NAME: ________________________

SEX: _________ BIRTH DATE: _______________ AGE ON RACE DAY: _______________  

ADDRESS:_____________________________________________________________________

CITY: _________________________________ STATE: ________ ZIP: _____________

TELEPHONE: _________________________

T SHIRT: XS  S    M    L   XL XXL
Shirt size guaranteed to registrations received by October 1 - Then as available on race day

I would like to make an addtional tax-deductible donation in the amount of $___________                                 

ATHLETE SIGNATURE: ____________________________________________
(parent or guardian must sign if under 18)


ENTRY FEES: $25 Pre-Reg - $30 Race Day ($15 Kids 18 and Under AND 70+) - Kids Fun Run is FREE - No Shirt - Finisher Medals!
(Mailed apps must be received by Oct 7 or they will be treated as late/race day fees.

MAKE CHECK PAYABLE TO: Uganda Farmers Inc
C/O Holler & Marecki LLC
31 Cherry Street Suite 109
Milford, CT 06460

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