Hope Springs Eternal 5K
May 10, 2008
Decatur, GA
OFFICIAL ENTRY FORM – PLEASE PRINT
Name: ________________________________________________________Phone _____________________
Street Address: ___________________________________________________________________________
City, State, Zip: ___________________________________________________________________________
Email: ______________________________________________________ (information will not be distributed)
Age: ______ M: ______ F: ______
T-shirt size (circle one): M L XL Event: 5K 5K Walk
__________ Entry fee
__________ Tax deductible donation to the hope clinic
__________ Total enclosed
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Waiver: I know that running a road race is a potentially hazardous activity, I am in proper physical condition to compete in this run/walk and assume all risks associated with my participation including, but not limited to, falls, contact with other participants, the effects of the weather including high heat and/or humidity, traffic and the conditions of the road, all such risks being known appreciated by me. I will not wear headsets or any device that restricts my hearing or other perception. In consideration of this entry, for myself and anyone entitled to act on my behalf, I waive and release the Hope Clinic, Emory University and its trustees, officers, agents, and employees and all race officials, volunteers, sponsors, and any other individuals or entities associated with this event. Furthermore, I hereby grant the agents of this event permission to use photographs, videotapes, motion pictures, recordings, audiotapes or any type of recording of me in this event in any way deemed appropriate by the Hope Clinic. |
Signature of Participant ________________________________________________ Date _______
Signature of Parent/Guardian
____________________________________________ Date ________
(if participant is under 18)
Please make all checks payable to
The Hope Clinic
Please return completed
registration form to:
The Hope Clinic
603 Church Street
Decatur, GA 30030