IAMBK 5K Charity Walk/Run Saturday- April 11, 2015 Fun Run for Kids (1 mile)—8:30 am (ages 8-12) 5K Adult Run—9:00 am Email: [email protected] Online Registration: website: www.iambkinc.org Mail to: P.O. Box 769; Auburn, Al 36830 ENTRY FEES: Child Early Registration (through 2/15/15) Regular Registration (2/15/15—4/10/15) Race Day Registration (April 11) Adult $10 $15 $20 $20 $25 $30 Registration forms and payment can also be dropped off at the Boykin Community Center office in a sealed envelope . Make all checks payable to IAMBK. Guaranteed T-Shirt Deadline: 3/27/15 Registration/Packet Pick-Up: Friday, April 10th Boykin Community Center Office Saturday, April 11th (Race Day) Boykin Auditorium Time ___________ 6:00—7:00 am Awards Ceremony @ 10:00 am Awards: All 1 mile finishers will receive treat bags. Prizes awarded to 1st, 2nd, and 3rd overall for men and women and group awards in each age group: 14 and under 15-19 20-30 30-40 40-50 50 and up Official Entry Form Check one: Fun Run for Kids ________ 5K Run for Adults ________ Please circle size: (5K only) YL YXL S M L Name : _____________________________________________ Sex: (circle one) Date of Birth: Age: ______________________________________ XL 2XL M F ____________ Address: ____________________________________________________________________________________ City: __________________________________ State: __________ Zip Code: __________________ Phone: ________________________________ Cell: _____________________________ Email: _______________________________________________________________________ Waiver/Event Disclaimer: This release must be signed by each participant or the parent/guardian of each participant. By adding your signature, you accept this waiver and disclaimer. I know that running a road race is a potentially hazardous activity. I should not enter and run the IAMBK 5K Charity Walk/Run unless I am medically able. By participating in this Event, I do so at my own risk. I assume all risk of injury, illness, damage or loss to me or my property that might result, including without limitation, any loss or theft of personal property. I consent to medical treatment in the Event of injury, accident and/or illness during the Event. I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) to release and discharge the organizers of this Event, its principals, its officers and directors, its staff, all sponsors and their representatives from any and all claims or causes of action (known or unknown) arising out of their negligence. I acknowledge that I have carefully read this ‘waiver/Event Disclaimer and fully understand that it is a release of liability. By my signature below, I am waiving any right that I may have to bring legal action to assert a claim against any and all Event sponsors for their negligence. I hereby grant full permission to any and all of the foregoing to use my name and likeness in any broadcast, telecast, video or print media reporting or advertising of the Event without compensation. I AGREE Sign here: ___________________________________________________________