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RACE REGISTRATION

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First Name *

Last Name *

Sex *

Age on 8.18.2012 *

Street Address *

City *

State *

Zip Code *

Telephone Number *

Email *

Emergency Contact *

Emergency Contact Telephone *

Emergency Contact Relationship *

Event *

Men's Shirt Size *

Women's Shirt Size *

Youth Shirt Size (For Kid's Events Only) *

Type Name As Acceptance of Waiver Below *

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WAIVER
In consideration of my entry being accepted, I intend to be legally bound, and do hereby for myself, my heirs and executors, waive and release all rights and claims of damages which may have or which may hereinafter accrue to me against Miles That Matter LLC, the Miles That Matter Foundation, West Chester Hospital/UC Health, West Chester Township, Voice of America Park, Buckeye Running Company, Fleet Feet Sports, Mojo Running, any subsidiary or political subdivision thereof, their respective officers, agents, directors, representatives, volunteers, successors, assignees and sponsors for any and all damages or injuries that may be sustained and/or suffered by me in connection with my association with entry or participation in the One Fun Run and Party. If I should suffer injury or illness, I authorize race officials to use their discretion and if necessary to have me transported to a medical facility. I attest and certify I am physically fit and am sufficiently able to participate in this event. I hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, motion pictures, recordings or any record of this event for any purpose. I have read the above release and understand that I am entering this event voluntarily at my own risk.