Lady of the Lake Relays Entry Form

Lady of the Lake Relays Entry Form
Saturday, March 7, 2009
Please Print Clearly

Team Name ___________________________________Team Category______________________________
(Please refer to award page on the web site for the team category)
Team Captain Name:____________________________ Team Captain Email___________________________

We will get our team packets at: Run-On Dallas Run-On Richardson Run-On Coppell
Run-On McKinney Race Day at the Event (Please pick up all team member packets together)
(You do not have to enter team members in the order of the leg they run. Which member runs each leg is up to the team)
Team Member 1: ____________________________________________________________________
Address__________________________________City__________________State_______Zip________
Email Address______________________________ Date of Birth __/__/______ Age on 3/7/2009_____
Sex: M F - T-Shirt S M L XL
Signature (For liability waiver below:)X ________________________________ Date: _________________
Team Member 2: ____________________________________________________________________
Address__________________________________City__________________State_______Zip________
Email Address______________________________ Date of Birth __/__/______ Age on 3/7/2009_____
Sex: M F - T-Shirt S M L XL
Signature (For liability waiver below:)X ________________________________ Date: _________________
Team Member 3: ____________________________________________________________________
Address__________________________________City__________________State_______Zip________
Email Address______________________________ Date of Birth __/__/______Age on 3/7/2009_____
Sex: M F - T-Shirt S M L XL
Signature (For liability waiver below:)X ________________________________ Date: _________________
Team Member 4: ____________________________________________________________________
Address__________________________________City__________________State_______Zip________
Email Address______________________________ Date of Birth __/__/______Age on 3/7/2009_____
Sex: M F - T-Shirt S M L XL
Signature (For liability waiver below:)X ________________________________ Date: _________________

WAIVER STATEMENT: Entry invalid if not signed. In consideration of the acceptance of this registration entry, 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 The Lady of the Lake Relays, Mellew Productions, the sponsors, promoters and all other persons and entities associated with the event or their agents or employees, or otherwise. 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 road, all such risks being known and appreciated by me. I further grant my permission 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 forgoing and certify my agreement by this signature, and my parent's/ guardian's if under 18.

$100 Four Person Team (Through February 1, 2009)	$ ________
$120 Four Person Team (February 2, 2009 through race day)	$ ________
$60 Two-Person Team (Through February 1, 2009)	$ ________
$70 Two Person Team (February 2, 2009 through race day)	$ ________
$30 Individuals (Through February 1, 2009)	$ ________
$40 Individuals (February 2, 2009 through race day)	$ ________