ST. PATRICK'S DAY 2009 REGISTRATION FORM
Last Name First Name Team Name Street City State Email Date of Birth & Age Zip 7K & 1 Mile: Wee Folks: Gender Small Medium Large XLarge Medium Large M F I will participate in: (please mark your event)
REGISTER ONLINE WITH NO USER FEE!! Click Here
Please Fill Out One Entry Form Per Participant, Thank You!
Preferred Shirt Size
Preferred Shirt Size
T-Shirt Guaranteed to: First 700 7K or 1 Mile Participants & First 200 Wee Folk Participants
Run of Luck 7K: please circle division
Runner Walker Wheelchair Handcycle Visually Impaired Ambulatory/Les Autres
Relay Team (Name of Fellow Relay Member: _________________________________)
1 Mile Shamrock Shuffle
Wee Folks Kids Dash
ALL PARTICIPANTS MUST SIGN RACE WAIVER:
St. Patrick's Day Run of Luck and all Sponsors Waiver: I know that running or walking a road race is a potentially hazardous activity.
I should not participate unless I am medically able and properly trained. I also know that, although police protection will be provided,
there will be traffic on the course route. I assume the risk of running into traffic, I also assume any and all other risks associated with
running in this event including but not limited to falls, contact with other participants, and effects of the weather and the condition of
the roads, all such risks being and appreciated by me know thing these facts, and in consideration of your accepting my entry, I hereby
for myself, my heirs executors, administrators or anyone who might claim in my behalf, covenant not to sue, and waiver release and
discharge all sponsors, the State of Indiana, City of Evansville, Vanderburgh County and race officials and volunteers, any and all claims
of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of my
participation in this event. This release and waiver extends to all claims of every kind of nature whatsoever, for reasons foreseen or
unforeseen, known or unknown. The under-signed waiver grants full permission to all sponsors and/or agents by them to use any
photographs, videotapes, motion pictures, recordings or any other record of this event for any purposes. Application for minors will be
accepted only with parent's signature.
___________________________________ ___________________________________
Participant Signature Parent/Guardian Signature if Participant is under 18
MAKE ALL CHECKS PAYABLE: RUN OF LUCK 7K
PLEASE MAIL ENTRIES TO: GORDON BENFIELD, 3701 NEGLEY AVE,
*TO PRINT ON 1 PAGE HIGHLIGHT FROM ST. PATRICK'S DAY FORM TO END OF WAIVER*
**To receive registration form as Word Document send request to LeeAnnGee@aol.com
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Email
Jim Bush







