Kidney Run and Walk - June 11, 2005
Web Entry Form

r 8K Run r 5K Walk

Name:___________________________________  Age on 6-11-05:______r Male r Female

Street:_______________________________________________________________________

City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:___________________________

Long Sleeve T-Shirt size: r S r M r L r  XL  r  XXL
Fees:
Pay NO entry!  Please bring pledge money with you to event site.
You must bring a minimum of $50 to receive a T-shirt.

CHECKS ARE PAYABLE TO:  National Kidney Foundation

Mail completed entry form and entry fee to: 
NKFI, 911 E. 86th Street, Suite 100, Indianapolis, IN 46240-1840

RACE PARTICIPATION AGREEMENT:
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all
rights and claims for damages I may have against any of the sponsors, organizer, National Kidney Foundation of Indiana,
City of Indianapolis, Tuxedo Brothers, Inc., 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