2015 5k Application 2/7/15

February 7, 2015  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 7, 2015 _____      Birth date __________    Male ___    Female ___


City __________________________ State__________ zip_________

Email Address ____________________________________________

Shirt Size:Youth  2T ___  3T ___ Extra Small ___  Small ___ Med ____ Large ___ XL ____

Adult Small ____   Medium____    Large____    X-Large____  XXL____  XXXL ____

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   c/o Karen Johnson    POB 524    Paxton, FL 32538

Registration $25.00                    Make Check Payable to: Cancer Freeze


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

CALL or TEXT   Karen 850-951-5385       Race Day Registration begins at 8:00 a.m


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