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print in portrait format if possible GOTR 5K Entry Form Name: _____________________________________________________________________________ Address:___________________________________________________________________________ City, State, Zip:___________________________________________________________________________________ Phone:________________________________________________ email:______________________________________________________________ @ ____________________________ Sex:_____________Age on Race Day:____________ Race Division (check one only): 5K Run _________ 5K Walk_________ Entry Fee: (check only one) ________$15 Race Day (Includes T-Shirt while supplies last) T-Shirt size: (circle one if applicable) S, M, L, XL Make checks payable to:
"OTR Chamber of Commerce" WAIVER: Waiver/ Release: (must be signed by participant): In consideration of the acceptance of my entry, I hereby waive on behalf of my heirs, executors and assigns, all claims of any nature arising from my participation in the Go OTR 5K Run/ Walk and do hereby release the Over-the-Rhine Chamber of Commerce, Greg McCormick, all sponsors, workers, officials and volunteers from any claim whatsoever arising from my participation in this event. I agree to abide by all the rules for participation and acknowledge that the Race Committee may refuse or return my entry at its discretion. I understand the risks for such a run and havetrained adequately in preparation. I have noted any relevant medical conditions on this form. ENTRY SIGNATURE:___________________________________________________________Date: __________________ Parent's Signature (if under 18): _____________________________________________________Date: ___________________ Emergency Contact: __________________________________________________________Phone________________________ |