Registration Form

Please print this form out, complete all sections and mail in with your non-refundable registration to:
Race for Research, P.O. Box 101435 Denver CO 80250-1435
PLEASE return mail-in entry forms by: August 22, 2009!
Make Checks Payable to: Cancer League of Colorado
Please put "Race for Research" in the memo line.

BIB NUMBER (official use only):
Age (on race day):
Sex (circle one): Male    Female
Event (circle one): Run    Walk
Do You Want
To Be Timed 		  Yes   No
Last Name:
First Name:
Street Address:
City:
State:
Zip:
Home Phone:
Email Address:
Visa #:
Expiration Date:
Signature for payment:
I am a cancer survivor:
 (please check in on race day)
I cannot participate but would like donate to CLC $

I would like to sponsor the following runner/walker:

________________________

   $
T-Shirt Size (circle one): Child       S       M       L       XL

Fee Amount Paid:
Make Checks Payable to:
Cancer League of Colorado
Please put "Race For Research" in the memo line

  $
Waiver: In participating in Race for Research and signing this form for myself (or participant if he/she is under the age of 18) I know that running and walking in a race can be potentially hazardous. I expressly knowingly assume all risks in this event, including, but not limited to falls, contact or collision with other participants, effects of weather including lighting, traffic and conditions of the road, all such risks being known and accepted by me. In consideration of these facts and the Race for Research acceptance of my registration I, for myself or the participant if he/she is under the age of 18 and anyone hereby waive release any and all claims against Race for Research, its affiliates, offices, directors, employees, all sponsoring businesses, and organizations and their agents and the City and Country of Denver or its agents from all claims and liabilities of any kind or nature. I hereby concent to receive any medical treatment which may be deemed advisable in the event of accident, injury and or illness during theRace for Research event. I also grant the Race for Research and all sponsoring businesses and organizations and their agents permission to use any photographs, motion pictures, recordings or any other record of the event in legitimate purpose.
Signature:
(if under 18, parent/guardian must sign)		    

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