
Saturday, February 7, 2009
First Name _______________________ Last Name _____________________________
Date of Birth __/__/____ Age on 02/07/09 __________ Sex
M
F
Address _____________________________________ City _______________________
State ___________ Zip __________ Email ____________________________________
Personal ChampionChip # (If you own one)______________________________________
T-Shirt Size S M L - XL XXL
I will participate in: Half Marathon 5k
Packet Pick-Up: (2/4/2009 - 2/6/2009)
Run-On Dallas
Run-On Richardson
Run-On Coppell
Run-On McKinney
Race Day at the event
WAIVER STATEMENT:
Entry invalid if not signed.
In consideration of the acceptance of this registration entry and being permitted
to participate in this event, I, the undersigned, assume full and complete responsibility
for any injury or accident, which may occur during my participation in the event
or while I am on the premises of the event. I hereby release and hold harmless
and covenant not to file suit against the sponsors, promoters, contributors,
municipalities, beneficiaries and all other persons and entities associated
with the event-including but not limited to Mellew Productions, or their agents
or employees from any loss, liability, or claims and any and all injury or damage
whether such injury or damage be caused by the negligence, gross negligence,
or misrepresentation of such parties or any other person or entity associated
directly or indirectly with the event or their agents or employees and are not
responsible for intentional, reckless, or negligent acts of third parties who
are outside their control. I will not enter and participate unless medically
and properly trained. I also know that although police protection will be provided,
there may be traffic on the course route. I assume the risk associated with
this event, including but not limited to falls, contact with participants, alcohol
consumption, the effects of weather including high heat and/or humidity, and
the conditions of the course, all such risks being known and appreciated by
me. I further grant my permission to The Texas Half to use any photographs,
videotape, motion pictures, recordings, or any other record of this event.T-shirt
size is not guaranteed. Fees are non-refundable. I have read the foregoing and
certify my agreement by my signature below, and my parent's/guardian's signature
if under 18.
Signature: X ____________________________________________ Date: _________________
Parent or Legal Guardian Signature, for minor: X ________________________ Date:
________
| Half Marathon Fees: | |
| $45 through December 5, 2008 | $____________ |
| $50 December 6, 2008 through Feb 1, 2009 | $____________ |
| $55 February 2 through Race Day | $____________ |
| 5k Fees: | |
| $15 through December 5, 2008 | $____________ |
| $20 December 6, 2008 through Feb 1, 2009 | $____________ |
| $25 February 2 through Race Day |
Mail application with check or money order payable
to Mellew Productions at:
TheTexas Half
P.O. Box 852856
Richardson, TX 75085