Jimmy Williams Memorial 5K Run Registration Form

1. Jimmy Williams Memorial 5K Run Registration Form Saturday, May 3, 2014 at 10am at Willow Metropark 22900 Huron River Drive, New Boston, MI 48164 • Event Cost: • Early Registration $25 – by April 5, 2014 • Late Registration $30 – between April 6 and April 30, 2014 • Day of Race $35 Mail Entries to: Jimmy Williams Memorial Run 26070 Whispering Willows Drive New Boston, MI 48164 Name: _________________________________________ Address: _______________________________________ City: _____________ State: _____ Zip Code: _________ Telephone: ______________ E-mail: ________________ Gender (M/F): ______ Age (on 5/3/14): ________ Select T-Shirt Size: Youth S M L XL Adult S M L XL In consideration of acceptance of my race entry, I, for myself, my executors, administrators, and assignees, do hereby release and discharge the Jimmy Williams Memorial Run/Scholarship, the City of New Boston, all sponsors, supporters, participants, and spectators for all claims of damages, demands, actions whatsoever in any manner arising from my participation in said event. I attest and verify that I have full knowledge of the risks involved in this athletic event, am physically fit to participate in this event, and have my physicians approval. Further, I hereby grant full permission to any of the aforementioned to use my photograph, videotape, film, motion picture, or record of my participation in this event. Signature _____________________________________________________________ Parent Signature (if participant is under 18) _____________________________________