Dur-A-Flex University - 5K Fun Race

Dur-A-Flex 5K Fun Run
2010 Registration Form
Event Date: Saturday, May 1, 2010 Application Deadline: Wednesday, April 28, 2010

Entry Fee:	Single Runner:	$20 $25 (After April 1, 2010)
	Pentagon Run:	$80 per team or $16 per person. * 5 people required to form a team * Every participating runner should enter their own registration form



Race Entered:	Run Walk
	Sponsorship Challenge ^{What is this?}
	Sponsorship Challenge Entry Only: Yes, I accept the challenge
	Pentagon Run ^{What is this?} (required to enter team name, captain's name, and 4 other runner's names below)
	Pentagon Run Entry Only: Team Name Captain

First Name:		Last Name:				Pentagon Runners:
Address:						5 Person Entry
City:		State:		Zip:
Phone:		Email:
Age:		Date of Birth:	(mm/dd/yy)
Gender:


Emergency Contact		Name:		Phone:
Waiver: I know that running is a potentially hazardous activity. I should not enter and run 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 hereby certify that I am in good health and I have trained to run the distance of the race, which I am entering. I assume all the risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and the conditions of the road, 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 into this race, I , for myself and anyone entitled to act on my behalf, waive and release Dur-A-Flex, its officers, directors, agents, volunteers and employees, all State, City, country, or other government bodies or locations in which events or segments of events are held, all sponsors, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named on this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I understand that bicycles, skateboards, roller skates or inline skates, animals, and radio headsets are not allowed in the event and I will abide by this guideline.
Yes, I have read and accepted the waiver

Choose your payment type:

Credit Card Number:
Expiration Date:	(mm/yy)
Card Holder Name:
Zip on Billing Address:
Amount: