Lake Johanna 4 Mile Registration Form       Saturday, March 24, 2012

WAIVER. In consideration of the acceptance of this entry. I, the undersigned, intending to be LEGALLY BOUND, for myself, my heirs, Executors and Administrators do hereby release Any and ALL sponsors of this race. Their representatives, successors an assigns form any and all liability arising from illness or injuries I may suffer as a result of participation in this race. I attest that and verify that I am physically fit and have sufficiently trained for the completion of this race. I understand that any sponsor may subsequently use for publicity and / or promotional purposes my name and / or photograph, video tape, motion picture and recordings of my participation in this event without obligation or liability to me. I also understand that Entry Fees are NOT REFUNDALBLE. I have read the for going and certify my agreement with my signature below.

Signature
(by parent or guardian if
participant is under 18) ___________________________________________________

PRINT OUT THIS ENTRY FORM AND MAIL IT BY MARCH 20 TO

or bring it to the race.

New and expired members make check payable to MDRA

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