Race for all Races
-
September 23,
2006
Web Entry Form
r 5 Mile Run
r 5K
Fitness walk
r One Mile Walk
Name:___________________________________ Age on 9-23-06:______r Male r Female
Street:_______________________________________________________________________
City:________________________________________State:_____________ Zip:___________
Day Phone:_________________________ Evening Phone:___________________________
E-mail address
_______________________________________________________________
T-Shirt size: r S r M r L r XL
r
XXL (shirts are limited on event day -first come first served)
All race entrants will receive free membership
with Asian American Alliance to promote civic leadership, diversity educational
programs such as "Race for All Races". Please
check box if you wish NOT to have a free membership
rNO
Fees Pre-registered on or before September 18 - without shirt - $15.00
Pre-registered on or before September 18 - with shirt - $20.00
After September 18 and raceday - $25.00
(shirts may be limited - size not guaranteed)
CHECKS ARE PAYABLE TO: Asian American Alliance
Mail completed entry form and entry fee to:
Tuxedo Brothers, 6265 Boone Ridge, Zionsville, IN 46077
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, organizers, City of Indianapolis, Asian American Alliance, 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.
Signature_______________________________________________ Date __________________
Parents or Guardians Signature if under age 18____________________________________ Date
_______
Incomplete/unsigned entries will not be accepted. - Entry form can be copied.
Deadline for mailing is September 18