iSMBJude,Inc - User Interface Layer for ONLINE REGISTRATION

MAIL-IN ENTRY FORM HOT SUMMER NIGHT
Save a few trees and save a few bucks! Online registrants receive a discount!

First Name

Last Name

Birthday

Phone

Address

City

State

Zipcode

Email

Gender / Age

Emergency Contact

Phone

*Select Event:
$30.00 - Mail-In 5k Run with Tshirt $15.00 - Mail-In Kid Run 800 meters with Tshirt $15.00 - Mail-In Kid Run 400 meters with Tshirt

MARK BEDENBAUGH, 736 Harden Street, Columbia, SC, 29205
Call (803) 799-4786
Web Address www.strictlyrunning.com
A parent or legal guardian's signature is required for all participants under the age of 18.
TO REGISTER BY MAIL. Sign it and mail to ETC, 736 Harden Street, Columbia, SC, 29205.
Make Check Payable to: ETC.
Entry fees and Credit/Debit Card Charges are non-refundable and non-transferable.

Athlete’s Release:
Athlete’s Release: In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators and assigns, release and discharge the sponsors and operators of the Hot Summer Night and their agents and employees from any and all claims for damages suffered by me as the result of my participation in or traveling to or from the event, to be held on 8/2/2008. I specifically release and discharge said operators and sponsors from all injuries or damages arising from or contributed to by any physical impairment or defect I may have, whether latent or potent, and agree that they are under no obligation to provide a physical examination or other evidence of my fitness to participate in such event, the same being my sole responsibility. Participants are subject to drug testing according to USATF Rules and IAAF Rule 144. I understand that I am voluntarily participating in the Hot Summer Night at my own risk and at my own request. I also give permission for the free use of my name, picture and voice at any broadcast, telecast, print account or any other account in any medium of this event. I understand that bicycles, in-line skates, skateboards and scooters are not permitted.
__________________________________________________________ Signature of Athlete or Parent's Signature if under age 18

Athlete’s Release:

Athlete’s Release: In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators and assigns, release and discharge the sponsors and operators of the Hot Summer Night and their agents and employees from any and all claims for damages suffered by me as the result of my participation in or traveling to or from the event, to be held on 8/2/2008. I specifically release and discharge said operators and sponsors from all injuries or damages arising from or contributed to by any physical impairment or defect I may have, whether latent or potent, and agree that they are under no obligation to provide a physical examination or other evidence of my fitness to participate in such event, the same being my sole responsibility. Participants are subject to drug testing according to USATF Rules and IAAF Rule 144. I understand that I am voluntarily participating in the Hot Summer Night at my own risk and at my own request. I also give permission for the free use of my name, picture and voice at any broadcast, telecast, print account or any other account in any medium of this event. I understand that bicycles, in-line skates, skateboards and scooters are not permitted.

__________________________________________________________
Signature of Athlete or Parent's Signature if under age 18