SEPTEMBER 27, 2008

8:00 AM

Cypress Creek Golf Course

Cabot, AR 72023

 

Benefiting Arkansas Children’s Hospital

A t-shirt to every registered participant / A custom medal to EVERY FINISHER!

Name: ________________________________________________________________________________

(First)                                                                          (Last)

Address: ______________________________________________________________________________

City, State, Zip _________________________________________________________________________

Phone # _______________________________________________________________________________

e-mail: ________________________________________________________________________________

Date of Birth: ____________________________________            Sex:                 M         F

Shirt Size:       Youth M          Adult S            Adult M           Adult L            Adult XL

Release:
I know that running and volunteering to work 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 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 and volunteering to work in club races 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 Cabot Country Cruisers, the City of Cabot, the RRCA, Greystone, 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 $15 pre-registered, $20 day of race.

Make checks payable to GREYSTONE CHARITABLE EVENTS

 

 

Amount Enclosed: ______________ (Additional donation to Arkansas Children’s Hospital welcomed.)

Check # _______________________