Arkansas 20K Benton, AR - Benton High School September 17, 2011 7:33 AM
ENTRY FORM - PLEASE PRINT	Grand Prix Website: www.ArkRRCA.com
Name: Last:	First:
Date of Birth:	Age on September 17, 2011:
Sex:     M       F	Email:
Address:	City, State, ZIP:
Shirts guaranteed to the first 150 pre registered runners. Shirt Size (Circle One):      S            M            L            XL            No Shirt* (* No shirt, subtract $5 from entry fee but minimum entry is $15 with or without a shirt)
Release: I know that running a road race is a potentially hazardous activity. I know I should not enter and run in this race 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 this race including, but not limited to falls, contact with other participants, the effects of the 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 accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Saline County Striders Road Runners Club, race officials and volunteers, the City of Benton, the County of Saline, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race. I grant permission to use any photographs or any other record of this event for any legitimate purpose.
Signature:
Parent Signature if under 18 years old:
Date:
Entry Fees: $15 if post-marked by 8/27/11 $20 if pre-registered by 9/10/11 $25 after 9/11/11, including race day Make checks payable to Saline County Striders, and mail to: Saline County Striders P. O. Box 866 Benton , Arkansas 72018