Registration Form - State Street Mile

Transcription

Registration Form - State Street Mile
Join us for the 16th Annual
June 7, 2015
Race Begins: State Street at Pedregosa Street
Race Ends: State Street at De La Guerra Street
Something for every person and
every dog who runs,
jogs or walks!
Registration Form
Mail completed form with payment to State Street Mile, 910 Bath Street, Santa Barbara, CA 93101 Name(s)*: _________________________________________________________________________________
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* For Family Fun Run only, you may list all participating family members on one registration form. Address: Zip: City/State: Phone: Email: Sex: □ M □ F Race Day Age: Date of Birth: Make Check Payable to DA State Street Mile (rain or shine – no refunds). Amount Enclosed: $ ____________ I’m Entering the Following Races: □ Age Group Mile □ Elite Mile □ Master’s Elite Mile □ Family Fun Run □ Dog Mile Adult T‐Shirt Size: □ S □ M □ L □ XL Youth T‐Shirt Size: □ XS □ S □ M Participating in two events (i.e. Age Group Mile and Family Fun Run)? Pay just ONE registration fee – whichever is greater! Early Registration Fees (Before May 17th) Registration Fees (After May 17th) $30 with State Street Mile T‐shirt │ $25 without T‐shirt $35 with State Street Mile T‐shirt │ $30 without T‐shirt Family Fun Run Fees (Through Race Day) $10 with State Street Mile T‐shirt │ $5 without T‐shirt * Pre‐race packet pickup June 6th – 11th from 11:00 AM to 4:00 PM at Santa Barbara Running *
110 Anacapa Street, Santa Barbara THE HOKA ONE ONE STATE STREET MILE BENEFITS THE COUNTY OF SANTA BARBARA DISTRICT ATTORNEY’S CRIME VICTIM EMERGENCY FUND. FOR MORE INFORMATION, VISIT WWW.SBMILE.COM OR CALL (805) 568‐2316. LIABILITY WAIVER: In consideration of your acceptance in this entry and allowing my participation in the State Street Mile on June 7, 2015, I hereby agree, on behalf of myself, my heirs, assigns and personal representatives, to assume any and all risks arising directly or indirectly from or attributable in any way to any act or omission to act on behalf of any such person, organization, or governmental unit in connection with my participation to this event, and I further agree to release and forever discharge the County of Santa Barbara, its officers, employees, agents, representatives, sponsors, promoters and affiliates from any and all liability, claims, damages, demands, loss, costs, attorney’s fees or other expense, and agree to waive any and all such liability, claims, damages, demands, loss, costs attorney’s fees or other expense against any such person, organization, or governmental unit due to my participation in this event. I also hereby give permission for the free use of my name and picture in any broadcast, telecast, or print media account of this event. In filling out this form, I acknowledge that I have read and fully understand my own liability and do accept the restrictions.