Valentine's Day 5K Entry Form

Valentine's Day 5K Russellville, AR - Bona Dea Trails February 11, 2012 See arkrrca.com for the heat starting times
ENTRY FORM - PLEASE PRINT	Grand Prix Website: www.ArkRRCA.com
Name: Last:	First:
Date of Birth:	Age on February 11, 2012:
Sex: M F
Address:
City, State, ZIP:
Division: ____5K Runner ____5K Walker ____Kids' 1 Mile Run
Sweetheart Division (optional): ____Married ____Unmarried Name of Sweetheart (each must submit own entry form):
Shirt Size: S M L XL
Release: I know that running in club races are potentially hazardous activities. I should not enter and run in this race unless I am medically able and properly trained. I assume all risks associated with running and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects of the weather, the conditions of the trail, all such risks being known and appreciated by me. I, for myself and anyone entitled to act on my behalf, waive and release the River Valley Runners, the City of Russellville, the RRCA, and all sponsors from all claims or liabilities of any kind arising out of my participation in the race and/or club activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.
Signature:	Date:
Parent Signature if under 18 years old:
Entry Fee: $20 preregistered, $25 day of race; add $3 per sweetheart entry. College student or younger running 5K: $10 Kids'1 mile race will be held after the men's race and is free. Make checks payable to ATU Women's XC Team and mail to: Tom Aspel ATU Women's XC Team 1604 Coliseum Drive Russellville, AR 72801