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H2Go Run! 2M Entry Form
July 20, 2019 -- 7:30am -- LRAFB University Park Area
Name:
Last:                                                                             First:

Date of Birth:                             Sex:      M     F             Age on 7/20/2019:

Address:

City, State, Zip:

Shirt Size:        S     M     L     XL      XXL     Youth M     Youth L

I would like to give an additional donation to support Alzheimer's Arkansas.

Select:          $5          $10           $15           $20           $40          Other:  $

For more information:  www.alzark.org or matthew.elmore@alzark.org


Release:
I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and run in this race 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 risks associated with running and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release  Alzheimer's Arkansas,, the County of Pulaski, Arkansas Runner LLC  and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or club activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.

Signature:                                                                                                          Date:

Parent Signature if under 18 years:                                                                   Date:


Make checks payable to Alzheimer's Arkansas and mail to:
201 Markham Center Drive
Little Rock, AR  72205


Fees:  $20 pre-registered, $25 day of race

For race information, 501-259-0646, jtrunner1958@gmail.com