2014 Cancer Freeze 5k Application

EVENT BEGINS AT 9:00 am   Florala State Park ~ Florala, AL

Benefit RUN  ~ Only 1st place in each category + Overall Male/Female/Walker/Runner
(please check)   Runner ______  Walker ______   Race Begins at 9:00 a.m.

Name ________________________________________  phone#________________

Age on February 1, 2014 _____      Birth date __________    Male ___    Female ___

Address__________________________________________________

City __________________________ State__________ zip_________

Email Address ____________________________________________

Shirt Size:

Adult Small____   Medium____    Large____    X-Large____  XXL_____ Youth Small _____

I know that running a road race is a potentially hazardous activity. I should not enter and run or walk unless I am medically able and properly trained. 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 the officials, sponsors,the Cancer Freeze Board of Directors and the city of Florala from all claims or liabilities of any kind arising out of my participation in the Cancer Freeze 5K Run. I further state that I am in proper condition to participate in this event.

________________________________________________________________________
Signature                       (Signature of Parent/Guardian if participant is under 18)

Mail Entry To:
5k Cancer Freeze                                   Registration $25.00

Karen Johnson                                       Race Day Registration begins at 8:00 a.m

P. O. Box 524         Paxton, Florida 32538

Make Check Payable to: Cancer Freeze

You may direct your 5k questions to: alligatortrot@yahoo.com

CALL or TEXT   Karen 850-951-5385

 

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