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1,000 Mile Club Registration 2014 1,000 Mile Club is open to current NCRC members only

1,000 Mile Club Registration 2014 1,000 Mile Club is open to current NCRC members only. Name: _______________________________________ Address: _____________________________________ City/State/Zip: ________________________________ Home Phone #: ______________________

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1,000 Mile Club Registration 2014 1,000 Mile Club is open to current NCRC members only

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  1. 1,000 Mile Club Registration 2014 1,000 Mile Club is open to current NCRC members only Name: _______________________________________ Address: _____________________________________ City/State/Zip: ________________________________ Home Phone #: ______________________ Email: ______________________________ Shirt: S M L XL (circle one) Male Female (circle one) Registration fee: $5.00 Registration Deadline: February 28, 2014 Make check payable to: Capital RunWalk 430 Woodburn Rd., Raleigh, NC 27605 WAIVER - SIGNATURE REQUIRED I know that running and participating in 1000 Mile Club activities is potentially hazardous. I should not enter and run in 1000 Mile Club activities unless I am able to safely complete any run. I assume all risks associated with participating in 1000 Mile Club activities including, but not limited to falls, contacts with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and anyone entitled to act in my behalf, waive and release Capital RunWalk, DPZ Properties, Inc., Road Runners Club of America, the North Carolina Roadrunners Club and all other sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in 1000 Mile Club activities even though the liability may arise out of negligence or carelessness on the part of the persons referred to in this waiver. I also grant permission for all of the foregoing to use any photographs, motion pictures, recordings, or any other record of my participation in club activities for any legitimate purpose. Signed _________________________________ Date _________ Signed _________________________________ Date _________ (Parent or guardian if under age 18)

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