SPRINGTOWN WAR MEMORIAL ASSOCIATION

SPRINGTOWN WAR MEMORIAL ASSOCIATION

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RUN TO REMEMBER Page I

                                                                                                SWMA 5K Run/Walk/Roll Activity Registration Form

                                                                                                                     Saturday, November 1, 2014


 

 Participant’s Name:______________________________________________ Date:_____________________


Birth Date:___/___/___ Telephone Number:_____________________


Mailing Address:___________________________________________


City, State, Zip:____________________________________________


E-Mail:___________________________________________________


T-Shirt Size:


XS________ XL________


S_________ 2XL_____


M________ 3XL_____


L_________


T-Shirts and Participant Bibs will be available for pickup at Springtown City Hall on Friday, October 31, 2014 from 3:00 pm until 5:00 pm. You may also pick up T-Shirts and Participant Bibs on the morning of the event at Springtown Veterans Park from 7:00 am until 8:00 am. If at all possible, we urge you to pick up your T-Shirts and Participant Bibs prior to the day of the event.


$25.00 Entry Fee per person                          Make Checks Payable to


$20.00 Entry Fee for families with                                  SWMA


3 or more paid entries.                                                   P. O. Box 444


$5.00 Discount per entry given to family                       Springtown, TX 76082 


members with 3 or more paid entries.                                               -or-


*In order to receive the discount, we must                     Deliver in person to:


have 3 or more paid individual family                           102 East Second Street
entries received and paid for together*                          Springtown, Texas 76082


 

You may run/walk/roll in honor or memory of any U.S. Armed Forces member who has served and/or still serves or who was Killed In Action or a Casualty Of War. Please supply us with a 4 x 6 photo of the individual and we will place the photo on your registration bib. The photo should be submitted with your registration. Please include name, rank, branch of service and Killed In Action Date (if applicable) of the individual on the back of your photograph.


**YOU CAN ONLY ADD A PHOTOGRAPH DURING PRE-REGISTRATION WHICH ENDS OCTOBER 24, 2014**








RUN TO REMEMBER Page II


SWMA 5K Run/Walk/Roll Activity Registration Form


Saturday, November 1, 2014


EMERGENCY INFORMATION:


Medical/Allergy Information (Please list N/A if none): ____________________________________________________________________________________________


____________________________________________________________________________________________


 

 WAIVER AND RELEASE OF ALL CLAIMS


 


Please read this form carefully and be aware that in registering yourself or your minor child/ward for participation in the above program you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of the program.


I recognize and acknowledge that there are certain risks of physical injury to participants in the above program and I agree to assume the full risk of any such injuries, damages, or loss regardless of severity which my child/ward or I may sustain as a result of participation in any activities connected or associated with this program. I waive and relinquish all claims my child/ward or I may have against the Springtown War Memorial Association, Springtown Veterans Park, City of Springtown, and their officers, agents, servants, employees, and volunteers as a result of participation in the above program.


I understand that photographs of participants may be taken and hereby consent to myself or my child/ward being the subject of photographs regardless of their form or content, for publicity, advertising, trade or any other lawful purpose whatsoever. I further release the Springtown War Memorial Association, Springtown Veterans Park, City of Springtown, and their officers, agents, servants, employees, and volunteers for any and all claims for damages for libel, slander, invasion of privacy or any other claims based on the use of such photographs regardless of their form or content.


I have read and fully understand the above program details and waiver and release all claims:


 

X______________________________________ Participant (18 years old or Guardian Signature)


 

Print name of participant or guardian if under 18 years of age:________________________________________



Date:________________________________