10K Rum Run Form
Sunday, May 25, 2014
Tualatin Commons
8063 Nyberg Street, Tualatin, OR 97062

10K Walk/Run, 5K Walk/Run, & Kid's 1K
Website - http://www.energyevents.com/10krumrun

 

Instructions
> Type in your information in the blanks provided.
> Print entry form & SIGN WAIVER (Entry will not be accepted without the signed waiver)
> Make Checks Payable to:
Energy Events

Mail to:
Energy Events
C/O 10k Rum Run
P.O. Box 70068
Vancouver, WA 98685



Please Choose One Option from the Drop Down Menu Below
ONE REGISTRATION FORM PER REGISTRATION
Race Day registration does not guarantee a race shirt.


10k Rum Run


First Name / MI / Last Name

Street Address

City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy

Age

Gender

Phone

Email

Tech-Shirt Size (GENDER SPECIFIC)
PURCHASE ADDITIONAL COMMEMORATIVE HOODIE FOR $40.00
Check#

Amount Enclosed



ENERGY EVENTS WAIVER
(Brochure, Website & On-Line Registration)
I know that participating in an organized athletic event is potentially hazardous, and that I should not enter to participate unless I am medically able and properly trained. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am physically fit and that I have sufficiently trained. I agree to abide by the competitive rules. I hereby take the following action for myself, my executors, administrators, heirs, next to kin, successors and assigns, or anyone else who might claim or sue on my behalf, and I hereby waive, release and discharge from any and all claims, losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bills, or theft which may arise out of or relate to my participation in this event. I agree not to sue, and to hold harmless Energy Events or any and all persons, sponsors, landlords (members and affiliates), advisors, lenders, property managers, tenants, volunteers, participants or government agencies for any and all claims or liabilities that I have waived, released or discharges herein. I know I will receive emails from Energy Events for promotions and also communication about upcoming events, newsletters and any specials for future EE events.

ENTRY FEES ARE NON-REFUNDABLE & NON TRANSFERABLE.



Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________