POKER RUN RIDE & POKER RUN RUN
Saturday Sept. 25, 2010
8:00 a.m. 3/10 Mile Run 10:00 a.m. 25/50 Mile Bike
Start: Shelbyville Chamber of Commerce
501 N. Harrison Street
Shelbyville, IN 46176
MAIL IN REGISTRATIONS DUE BY September 18, 2010
PRINT, FILL OUT AND MAIL TO:
Energy2Action, LLC
1223 Oak Lane
Shelbyville, IN 46176
Name:
Address:
Address:
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T-shirt
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Signature:
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of Shelbyville, Shelbyville - Shelby County Library, Special Olympics, Firefighter’s Auxiliary, Energy2Action, LLC, and The Shelby Roadrunners, for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event. I understand and acknowledge that participating in this run/walk and cycling event may expose me to dangers from both known and anticipated risks. I understand that the course is not closed to traffic and that I could be at risk from traffic, other runners and cyclists, bad weather, and rough terrain along the course. I acknowledge that some sections of this run and bike course are off road or rough road and may contain areas where I will be at risk of tripping and falling. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Which Event are you Entering?
Total Enclosed
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