This is Bill. STROLL-N-ROLL APPLICATION
June 5, 2010 - 8:00 AM

ENTRY FEE: Individual early registration by May 28, 2010 - $20.00.  Individual race day $25.00
Relay Team early registration by May 28, 2010 - $30.00.  Relay Team race day $40.00

MAIL APPLICATION TO:  DOTHAN RUNNERS    PO  BOX  887   DOTHAN, AL  36302

 

NAME: ____________________________________________    AGE (on 6/5/10)_______      SEX _____

ADDRESS: __________________________________  CITY:_________________STATE: ____ZIP:_____ 

Tel#:________________________                        E-Mail:____________________________________

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T-SHIRT: Sm. Med. Lg. X-Lg                                                         DATE OF BIRTH: ______________________

CHECK ONE:   INDIVIDUAL _____     TEAM   ______      TEAM CATEGORY_____  (Male, Female, Mixed)

                            NAME OF TEAM MEMBER __________________________________

Please read and sign waver.   (PARENTS must read and sign for any PARTICIPANT  under the age of 18)

I know that running and biking a road race is a potentially hazardous activity. I should not enter and run and bike 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 assume all risks associated with entering in this event including, but no 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, I, for myself and anyone entitled to act on my behalf, waive and release the Dothan Runners Club, the City of Dothan, and all race sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the 2010 Stroll-N-Roll Duathlon.

SIGNATURE: ___________________________________                                    DATE:____________________

 

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