PRA Christmas Dash
December 12th, 2009 5:00PM

Directions: 1. Fill out this form on your screen. 2. Print your form. 3. Mail it in with your entry fee.

Forms must be completed on the screen then printed. Incomplete or handwritten forms will not be accepted.

First Name: Last Name:
Age:   Date of Birth: Male Female

Address:
City: State: Zip Code:
Phone Number:    
Email Address:

Are you a PRA Member? Yes No

Make check payable to: PRA Early Registration if postmarked by 12/01/2009

Mail to: PRA
Christmas Dash
P.O. Box 12552
Pensacola, Fl 32591-2552

Early Registration: PRA Members: Children & Adults: $5; Non-members: Adults $10, Children $5

Late registration: (Dec 2 – 12th) Adults $10, Children $5. DO NOT MAIL AFTER 12/07/09.
Standard Waiver (Must be signed by all participants!): I know that running a road race is a potentially hazardous activity, which could cause injury or death. I should not enter and run unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, am in good health, and am properly trained. I agree to abide by any decision of a race official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with running in this event, included but not limited to falls, contact with other participants, the effects of the weather, including cold, heat and humidity, traffic, and the conditions of the road all such risks being known and appreciated by me. I understand that bicycles, skateboards, baby joggers, skates or blades, animals, and radio/tape/CD headsets are not allowed in the race and will abide by this guideline. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Pensacola Runners Association Inc., Road Runners Club of America Inc., any city, county, state, and national government entity responsible for areas used in conjunction with this event, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of persons named in this waiver.  Further, I grant permission to all the foregoing to use my name and images of myself in any photographs, motion pictures, results, publications or any other print, video graphic, or electronic record of this event for legitimate purposes.  I have read the above release and understand that I am entering the 2009 Christmas Dash at my own risk..
Signature: Date:
( Signature of parent or guardian if entrant is under 18)