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REGISTRATION FORM
Age on race day___Sex___ Walk____ 5.3mi Run_____
1.5mi Junior Run(11 - 16)_____ Phone(___)________
Name:________________________________(Please Print)
Address:____________________________________________________________
City:_________________________________ State:_____ Zip:______________
Check Enclosed:_______ Race Registration:____Contribution:____
Hat:____ or Visor:____
MC/Visa:__________________________________ Exp date:______________
Waiver of liability: In consideration of participating in this event I hereby indemnify and hold harmless and release Feather River Land Trust, their agents or employees, race directors and volunteers from any and all liability for any injuries suffered by me or my minor child arising from this race/walk and I assume all risk for any injuries received. I will obey all race rules and adhere to the established race course and understand that any deviation from race course may result in disqualification. I further acknowledge that I am solely responsible and assume all liability for any accident or injury which may result from my deviation from prescribed race course.
X____________________________________Date_________________
All entrants must sign wavier (parent or guardian if under 18)
Mail registration form to: Round Valley Run/Walk, c/o Ben Sawyer, P. O. 293, Meadow Valley, CA 95956-0293 . Make checks payable to: Feather River Land Trust
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