United Way Mississippi River Bridge Run - 5K - April 5, 2008 - Destrehan, LA
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| Race Number |
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___ $20.00 All entrants registered by March 31. | |
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___ $25.00 All entrants registered after March 31. | |
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___ $20.00 Day of race no T-shirt entry. | |
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Official Use Only
Checks payable to: New Orleans Track Club, Inc. Entries paid by Credit
P.O. Box 52003 Card may be faxed to:
New Orleans, La 70152-2003 504-469-9268
All entry fees are non-refundable.
PLEASE PRINT CLEARLY:
____________________________________ ________________________________ ____
Last Name First Name MI
____________________________________________________________________________
Street Address/Apartment Number
____________________________________________ _____ _________ _____ _____
City State Zip Code Sex M Sex F
______-______-________ ____ /____ /____ ____ Walker: _____ _____
Telephone Number Date of Birth Age Yes No
____________ Shirt ___ ___ ___ ___ ___ ___________________________________
NOTC Number Size: S M L XL XXL Email Address
Credit _____ _____ __________ __________ __________ __________ ____-____
Card: Visa M/C Account Number Exp Date
________________________________________________________________ _________
Signature of cardholder Bank Code
I know that running a roadrace is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all the risks associated with running in this event including but not limited to fall, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and other conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in considerations of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the New Orleans Track Club, Inc. and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the forgoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose.
________________________________________________________ __________________ Signature Date ________________________________________________________ __________________ Signature of Parent or Guardian if entrant is under 18. Date