Roosevelt
Run 5K
Thursday,
August 23, 2012, 7:00 PM
Trailhead
of GW Parkway Trail
at
Across
from
Run
along the
www.safetyandhealthfoundation.org/20120823
|
Enter
on-line
Enter by mail $15 by August 18, $20 by August 22, $25 on August 23 |
`.![]()
Roosevelt
Make checks payable
to SHF,
.
Name
___________________________________________________________ Gender (M F) [__] Age as of
08/23/2012
[___]
Address
_________________________________________________________
Birthdate __ __ -
__ __ - __ __ __ __ (mm-dd-yyyy)
City ST
ZIP
______________________________________________________
Phone __ __ __ -
__ __
__ - __ __ __ __
E-mail
___________________________________________________________
Enclosed
is my entry fee:
Mail-in
prices: Until
August 18: [_]
$15
After
August 18: [_]
$20
Race-Day: [_] $25
(Enter
on-line )
Enclosed
is an additional tax-deductible donation of $_____ to [_] SHF
![]()
By entering this
event, I
agree, warrant and covenant as follows:
I know that running is a potentially hazardous activity. I should not enter or run in club activities
unless
I am medically able and properly trained.
I agree to abide by any decision of a race official relative to
my
ability to safely complete the run. I
assume all risks associated with running in this race including, but
not
limited to, falls, contact with other participants, the effects of
weather,
including high heat and/or humidity, the conditions of the road and
traffic on
the course, all such risks being known and appreciated by me. Having read this waiver and knowing these
facts, and in consideration of your acceptance of my application I, for
myself
and anyone entitled to act on my behalf, waive and release Safety and
Health
Foundation, Arlington County Virginia, National Park Service,
Georgetown
Running Company, Road Runners Club of America, USATF, and all sponsors,
their
directors, officers, employees, agents, representatives and successors
from all
claims or liabilities of any kind arising out of my participation in
this event
even though that liability may arise out of negligence or carelessness
on the
part of the persons named in this waiver.
I acknowledge that the application fee shall be non-refundable. I agree that the sponsors of this event may
use my name and likeness for publicity purposes.
Signature
_________________________________________________________
(parent or guardian if under 18) Date _______________