Make check payable to Scottsdale Weight Loss Center PLLC
Mail to: Arizona RunningEvents Co. ~ 1963
E. Kentucky Ln. ~ Tempe, AZ ~85284
Please fill in this form, print
it out and
mail it in WITH YOUR CHECK
Last Name:First Name:
Address:
City: State:
Zip Code:
Phone:
Email:
Age on Race Day:
Gender:
Me
F Event: 5K
Run/Walk
T-Shirt Size S
M L
XL
XXLXXXL
Entry Fees:
Postmarked by
Postmarked after Fill in Amount
11/06/08
11/06/08
5KRun/Walk
$20.00
$25.00
Optional Donation to The American Heart Association
Total
Please read the waiver and sign the form. Thank
You.
RELEASE FORM (MANDATORY):All applications MUST be signed to
enter this event. No entry accepted without fee. NO REFUNDS.
WAIVER:
In consideration of accepting this entry, I, the undersigned, intending to
be legally bound hereby, for myself, my heirs, executors, and administrators
waive and
release any and all rights and claims for damages I may have against
Scottsdale Weight Loss Center PLLC, City of Scottsdale,
Arizona RunningEvents Co., and anyone
associated with this event, their representatives, successors and assigns
for any and all injuries suffered by me in said event. I will additionally
permit the free use of my name and pictures in broadcasts, telecasts,
newspapers, web sites, etc.
