Entry Form

NCJLS Alumni Blazin’ Boot 5K Run-Walk
Saturday, January 10, 2015 at 8:00am
RMB Regional Fairgrounds, Robstown, TX 78380
Registration Form
Run or Walk ($25) until December 31st - then ($30) until January 8th
$35.00 on Friday, January 9th at Packet pickup
$40.00 Race Day Registration (6:30 – 7:30 AM)
(No Refunds: Rain or Shine)
First Name:
Age:
Middle Initial:
Gender:
M
Last Name:
F (circle one)
Email:
Day Phone: (
)
Evening Phone:
(
Ext:
)
Address:
Apt:
City:
State:
*** Circle One***:
Zip Code:
5K Run
5K Walk
Event Shirt Size (Your size MAY NOT be available): (circle one)
Youth (L)
Adult (S)
Adult (M)
Adult (L)
Adult (XL)
Adult (XXL)
Event Fee (Shown at the top of the form):
$
Please make checks payable to: “NCJLS-5K Run”
Mail check to: NCJLS, P.O. Box 260968, Corpus Christi, TX 78426-0968
Waiver and Release
I know that participating in a run or walk event is a potentially hazardous activity and I should not enter and participate unless I am medically able and
properly trained. I agree to abide by any decisions of any Race Official relative to my ability to safely complete this event. I assume all the risks
associated with participating in this event including but not limited to: falls, the effects of weather including rain, high heat and humidity, contact with
other participants, traffic and the conditions of the road, all risks being known and appreciated by me. Having read the waiver and knowing these facts
and in consideration of accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release the Race Director, Race Sponsors,
Volunteers, Race Officials, Zeri Events Inc., Pendgo Timing Inc., Alfredo P. Ramirez, P.E., Bay Area Bicycles, Nueces County Junior Livestock Show,
NCJLS Alumni, City of Robstown, and RMB Regional Fairgrounds their representatives and successors from all claims and liabilities of any kind arising
out of my participation in this event even though liability may arise out of negligence or carelessness of the persons named in the waiver.
Signature:
Date:
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