2007 Family Discount Mail-In Form – Get in Gear 10K & 5K

You have selected the correct link if the following information applies:

There are a minimum of three participants living in one household doing either the 10K or the 5K.
Must be obvious family members
Entry form must reflect same address for three or more in same family.

Must be post-marked no later than April 21 NOTE: ENTRIES ARE NEITHER EXCHANGEABLE OR REFUNDABLE

BIB # _____________
         ^{For Office Use Only}
             Reissued BIB # Fee is $5.00 BIB # _____________
         ^{For Office Use Only}
             Reissued BIB # Fee is $5.00 BIB # _____________
         ^{For Office Use Only}
             Reissued BIB # Fee is $5.00 BIB # _____________
         ^{For Office Use Only}
             Reissued BIB # Fee is $5.00

^{Family 10K
& 5K Entry Fee: $20.00 per family member
(minimum 3 in same household)}

Family Last Name:

Runner #1 First Name:

10K

Age:

Birth date:

Gender:

Male

Female
(Age on April 28, 2007) Month Day Year Is this your first Get in Gear race? (circle one) Yes No

Runner #2 First Name:

10K

Age:

Birth date:

Gender:

Male

Female
(Age on April 28, 2007) Month Day Year Is this your first Get in Gear race? (circle one) Yes No

Runner #3 First Name:

10K

Age:

Birth date:

Gender:

Male

Female
(Age on April 28, 2007) Month Day Year Is this your first Get in Gear race? (circle one) Yes No

Runner #4 First Name:

10K

Age:

Birth date:

Gender:

Male

Female
(Age on April 28, 2007) Month Day Year Is this your first Get in Gear race? (circle one) Yes No
*Note: If you wish to enter 5 or more family members, please submit on a blank sheet of paper attached to form.

Address:

City:

State:

Zip:

Phone:

E-mail ____________________________

Would you like to make a donation to 2nd Harvest Heartland? Enter Donation Amount Here: $ _______________
(Amount will be added to total - to find out more go to www.2harvest.org)

WAIVER

I know that running a road race 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 risks associated with participating in this event including, but not limited to; falls, contact with other participants or spectators, the effects of the weather-including heat or high humidity-traffic or the conditions of the road surface, 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 for my behalf, waive and release the Get in Gear, INC., the management personnel, the Minneapolis and St. Paul Park Boards and all sponsors of the event, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability might arise out of negligence or carelessness on the part of the persons named in this waiver. I understand that this event is being timed using ChampionChip technology and I will be assigned a timing chip. I agree to accept responsibility for the chip and will return it after the event. My failure to return the chip may result in a $30.00 assessment.

I understand my failure to abide by the prohibition of headphone devices will result in rejection of medical and liability insurance coverage should incidences arise on the course affecting me.

I hereby irrevocably consent to and authorize the use and reproduction by Get in Gear, Inc., or anyone authorized by Get in Gear, Inc., of any and all photographs and video taken of me for any purpose whatsoever, without further compensation. All photographs and videos shall constitute Get in Gear, Inc. property.

I have read and agree to the above.

Signature: ______________________________________________ (If you are under age 18, parents must sign here for you)
Signature: ______________________________________________ (If you are under age 18, parents must sign here for you)
Signature: ______________________________________________ (If you are under age 18, parents must sign here for you)
Signature: ______________________________________________ (If you are under age 18, parents must sign here for you)