Ticket to Music Fest included with registration!

August 20, 2011 * 7:30 am CDT

Pre-registration until August 13^th

  $20.00

Remit to: Screentech
Po box 1212
Dothan Al 36302
Attn: Musicfest 5k

Same day registration

6:30 am

$25.00

MAKE CHECKS PAYABLE TO: ALS
Registration & Waiver Form
I know that running a road race 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 assume all 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, I, for myself and anyone entitled to act on my behalf, waive and release Downtown Music Fest Organizers, 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 2011 Downtown Music Fest 5k run.

NAME:_______________________________________________             SEX:_______________     AGE: (on 8-20-11) ____________________

ADDRESS:______________________________________________________________________     DOB:_______________________

CITY:_____________________________   STATE:_____________       ZIP:________   PHONE:____________

E-Mail address:_____________________________________________

Pre-register for preferred size.  We do not guarantee all sizes will be available on race day. 

 _____Small     _____Medium     _____Large     _____X-Large
 

Signature _________________________________________________________Date_____________
(Parent or guardian must sign if entrant is under 18 years of age)