Mutt Strutt Registration
Mutt Strut Registration Form April 11th, 2015 5k Run and 1 mile dog walk Meet at MSU Gate on Olive St. and 15th Pre-Reg. 5k Run 1 Mile Dog Walk 8:30am 9:30am ____ $25 ____ $15 Race Day _____$30 _____$20 (Proof of vaccinations required, rabies and distemper) Pre-Registration Deadline, Monday, March 30th Payment Type: __ Check __ Cash __ Credit Additional Donation ________ Total: _______ Make Checks Payable to: AHT/Pre-Vet Club Mail Form to: AHT/Pre-Vet Club 100 AHT Center Murray, KY, 42071 Drop off form to: Humane Society, 607 Poplar St., Murray Name _______________________________________________________________ Address _____________________________________________________________ ____________________________________________________________________ Phone____________________Email______________________________________ Any Additional questions contact Danyelle Harding at [email protected] T-shirt size—Check One (Guaranteed to all pre-registered) Small Medium Large X-Large XX-Large In consideraon of your acceptance of the race entry, I, for myself, my heirs, and executors, forever release, and/all rights, demands, claims, for damage and causes of suite acon known or unknown that I may have against Animal Health Technology/ Pre-Vet Club and Humane Society of Calloway County and all parcipaon in said race, that I assume those risk, that I will assume and pay my own medical and emergency expenses in the event of an accident , illness or other incapacity, regardless of whether I have authorized such expenses and that I am physically fit and sufficiently trained to parcipate in the race. If I have a heart condion or high blood pressure, I cerfy that I have my physicians approval to parcipate in this event, with obligaon or signature. I acknowledge that any photographs taken at the event may be used in electronic publicaons, promoonal literature or adversing. I also understand the entry fee/donaon is nonrefundable. Signature (Parent or Guardian required if under 18)
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