Homecoming 5K

Bemidji State University

Homecoming, Saturday, September 27, 2008 


Last Name                       First Name                                Age on    Sex  

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                                                                          Sept 28    M/F                 


Mailing address (include apt. # and c/o)                    

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City and State                                                       Zip/Postal Code

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Birth date      Area Code       Telephone                          

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 Mo  Day Yr   

E-Mail Address (optional for future race information) 

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Shirt Size  Adult Small |__|  Adult Medium |__|   Adult Large |__|    Adult X Large |__|

WAIVER. Knowingly and at my own risk I do hereby apply to enter an athletic contest. I hereby agree that I release and discharge the Bemidji State University, Vacation Sports, and other parties associated with the Alumni 5K from all claims, demands, injuries, damages, actions or causes of action from all acts of active or passive negligence on the part of such corporations, organizations, clubs, their servants, agents or employees, and hereby assume all the risks associated with my participation in the event. Further, I hereby grant full permission to any and all of the foregoing to use my name, likeness and voice, as well as any photographs, videotape, motion pictures, recordings and any other record of this event in which I may appear for any legitimate purpose including broadcast of the event, the reuse in any media of this broadcast and in advertising and promotion.

Signature
(by parent or guardian if
participant is under 18) ___________________________________________________

MAIL ENTRY FORM WITH $20 BY SEPTEMBER 26 TO

Make check payable to Bemidji Alumni Association

MORE INFORMATION