Registration Form for Tortoise and Hair 5K/1Mile Run
Saturday, March 1, 2014
Begins and Ends at University Baptsit Church (Leeward at Highland Road)

Each runner must fill out a separate form. Signed forms and payment (check) are to be mailed to:

Marilyn Hammond
5218 Riverbend Blvd.
Baton Rouge, LA 70820

Event: 5K      1 Mile   
First Name:
Last Name:
Gender: Male    Female   
Age:
T-Shirt Size: YM    YL    Adult S    Adult M
Adult L    Adult XL   Adult XXL
Name of Team:
(if team member)
Email:
Day Phone:
Evening Phone:
Address:
City/ST/Zip:      
Registration Type: $20 Adult Pre-Registration
$10 12 & Under Pre-Registration
$25 Race Day Registration
I cannot run, but enclosed is
my tax deductible gift of:
$1000    $500    $250    $100    Other:

If paying by check, please make check payable to: National Alopecia Areata Foundation or NAAF.

Donations are tax deductible. NAAF is a 501c(3) organization.

Participation Legal Waiver — Please send waiver along with payment for race entry. I know that running and/or volunteering to work in Club South Runners events are potentially hazardous activities. I should not enter and or run in Club South Runners activities unless I am medically able and properly prepared and/or trained. I agree to abide by any decision of race/event officials relative to my ability to safely compete or assist in this organization’s activities. I assume all risks associated with running and/or volunteering to work in Club South Runners events including, but not limited to, falling, 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 Club South Runners waiver and knowing these facts and in consideration of your acceptance of my entry for racing, I, for myself and for anyone entitled to act on my behalf, waive and release the Road Runners Club of America, Club South Runners, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these Club South Runner’s activities, even though the liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of my participation in any Club South runners event for any
legitimate purpose.


Signature: _______________________________ Date: ____________
                    (parent or guardian if under 18)