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4k
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<br /> November 10 th 2012
<br /> First Name Last Name
<br /> Address
<br /> City State Zip
<br /> Email Address (for race communication only - Final Stretch will not distribute or sell emails)
<br /> Phone Number
<br /> F / / S M L XL
<br /> Gender Age Date of Birth T -Shirt Size
<br /> Events & Pricing Descriptions:
<br /> Event By Nov 6 After Nov 6th
<br /> 10K $33.00 $38.00
<br /> 5K $33.00 $38.00
<br /> Circle Event: 10K 5K This is a Female only event
<br /> $5 of each entry fee goes to MN Ovarian Cancer Alliance.
<br /> Extra Donation to the MN Ovarian Cancer Alliance $
<br /> Amount Enclosed: US$ (Must be postmarked by: Monday, August 5
<br /> (Race fees are non - refundable; bib numbers are non - transferable)
<br /> Make check (no credit cards allowed) payable in US$ and send along with registration form to:
<br /> Final Stretch, Inc.
<br /> P.O. Box 121
<br /> Nerstrand, MN 55053
<br /> ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
<br /> 1 acknowledge that the Diva Dash Run events are a test of a person's physical and mental limits and carry with it the potential for death, serious injury and property loss. The risks include, but are
<br /> not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants,
<br /> spectators, volunteers, coaches, event officials, and event monitors, and/or producers of the event, and dehydration. I hereby assume all the risks of participating in this event. 1 certify that I am
<br /> physically fit, have sufficiently trained for participation in this race, and have not been advised otherwise by a qualified medical person. 1 acknowledge that this Accident Waiver and Release of
<br /> Liability (AWRL) form will be used by the event holders, sponsors and organizers, in which 1 may participate and that it will govern my actions and the responsibilities at said event. In
<br /> consideration of my application and permitting me to participate in these events, I hereby take action for myself my executors, administrators, heirs, next of kin, successors, and assigns as
<br /> follows: Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter accrue to
<br /> me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSON(S): Final Stretch, Inc, Final Timing, Inc, their directors, employees, volunteers, Event Organizers and
<br /> Promoters, Sponsors, Advertisers, Host Cities, Local Organizing Cotnmittees, Venues and Property Owners upon which the Event takes place, Law Enforcement Agencies and other Public
<br /> Entities providing support for the Event, and each of their respective parent, subsidiary and affiliated companies, officers, directors, partners, shareholders, members, agents, employees and
<br /> volunteers (Individually and Collectively, the "Released Parties" or "Event Organizers "), with respect to any liability, claim(s), demand(s), cause(s) of action, damage(s), loss or expense
<br /> (including court costs and reasonable attorneys fees) of any kind or nature ("Liability") which may arise out of result from, or relate to my participation in the Event, including claims for Liability
<br /> caused in whole or in part by the negligence of the Released Parties. I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness
<br /> during the event. I understand that at this event I may be photographed. 1 agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers,
<br /> sponsors, organizers and/or assigns. This AWRL shall be construed broadly to provide release and waiver to the maximum extent permissible under applicable law: 1 hereby certify that I have
<br /> read this document; and, I understand its content.
<br /> Participant Signature Date
<br /> Parent/Guardian Signature (if under 18) Date
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