Name:
Address:
Address:
City:
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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, The Intelliplex Park,  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  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, ice and rough terrain along the course.  I acknowledge that some sections of this run  course may be 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.





Age on Race Day:
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RUDOLPH RUN
5K Run/Walk
December 24, 2013
9:00 a.m.
Free Kids' run 8:30 a.m.

$20.00 Entry Fee
On Line Pre-registration ends on 12/16/13
(Pre-registrants receive a warm pair of fleece gloves)

Race Day Registration
$25.00
(Gloves are not guaranteed to race day registrants)

Intelliplex Conference Center
2150 Intelliplex Dr.
Shelbyville, IN  46176
Glove Size:
For free Kids' Run (gloves not included),
please enter child's name:
Are you registering yourself or someone else?
If you are registering someone else, what is YOUR name?
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