Mutt Strutt Registration

Mutt Strut
Registration Form
April 11th, 2015
5k Run and 1 mile dog walk
Meet at MSU Gate on Olive St. and 15th
Pre-Reg.
5k Run
1 Mile Dog Walk
8:30am
9:30am
____ $25
____ $15
Race Day
_____$30
_____$20
(Proof of vaccinations required, rabies and distemper)
Pre-Registration Deadline, Monday, March 30th
Payment Type: __ Check
__ Cash
__ Credit
Additional Donation ________
Total:
_______
Make Checks Payable to:
AHT/Pre-Vet Club
Mail Form to:
AHT/Pre-Vet Club
100 AHT Center
Murray, KY, 42071
Drop off form to: Humane Society, 607 Poplar St., Murray
Name _______________________________________________________________
Address _____________________________________________________________
____________________________________________________________________
Phone____________________Email______________________________________
Any Additional questions contact Danyelle Harding at [email protected]
T-shirt size—Check One (Guaranteed to all pre-registered)
Small
Medium
Large
X-Large
XX-Large
In consideraon of your acceptance of the race entry, I, for myself, my heirs, and executors, forever release, and/all rights,
demands, claims, for damage and causes of suite acon known or unknown that I may have against Animal Health Technology/
Pre-Vet Club and Humane Society of Calloway County and all parcipaon in said race, that I assume those risk, that I will assume and pay my own medical and emergency expenses in the event of an accident , illness or other incapacity, regardless of
whether I have authorized such expenses and that I am physically fit and sufficiently trained to parcipate in the race. If I have
a heart condion or high blood pressure, I cerfy that I have my physicians approval to parcipate in this event, with obligaon
or signature. I acknowledge that any photographs taken at the event may be used in electronic publicaons, promoonal literature or adversing. I also understand the entry fee/donaon is nonrefundable.
Signature (Parent or Guardian required if under 18)