Dam Night Run 5K
Lake DeGray, AR
July 31, 2010
8:00 PM

Arkansas Grand Prix RRCA Running Series
ENTRY FORM - PLEASE PRINTGrand Prix Website: www.ArkRRCA.com
Name: Last: First:
Date of Birth: Age on July 31, 2010:
Sex:     M       F
Address:
City, State, ZIP:
Shirt Size: Youth M        Youth L        S         M         L         XL        XXL (add $2)
Release:
I know that running a road race is a potentially hazardous activity. I should not participate 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 course. In consideration of the race officials' acceptance of this entry, all participants, intending to be legally bound hereby, for myself, my heirs, executors, administrators, and assigns waive and release Club Arkadelphia Running Club, the RRCA, and any and all sponsors and representatives, successors, and assigns from any and all rights and claims for damages I may have arising out of any injuries and/or illnesses suffered by me or as a result of this event, including those which may be attributed to weather conditions. I attest and verify that I will participate in this event as a foot race entrant, that I am physically fit and ahve sufficiently trained for the completion of this event adn my physical condition has been verified by a licensed medical doctor. Further, I hereby grant full permission to any and all of the foregoing to use my name and any photographs, videotapes, motion pictures, recordings or any other record of me participating in this event for any purposes without obligation, compensation or liability to me. I have read the entry information provided and certify my compliance by my signature on the registration form. I understand the entry fee(s) I pay are non-refundable.
Signature:
Parent Signature if under 18 years old:
Date:
Entry Fee: $20 if postmarked by July 23rd; $30 thereafter
$15 for ages 18 and under
No registration after 7:00 PM on the day of race!


Make checks payable to Club Arkadelphia Runners and mail to:
P. O. Box 422
Arkadelphia, AR 71923