Keep Athens-Limestone Beautiful, Inc.

 2010 DUCK & RUN 5K

Registration Form

8:00 a.m., Saturday, September 18, 2010

Make checks payable to KALB and mail to:     KALB, Duck & Run, P.O. Box 1089, Athens, AL 35612

NAME:    First_______________________________Last___________________________________________

 Address:__________________________________________________________________________________

 City:_____________________________________  State:______________ Zip:_________________________

 Phone:________________________ e-mail:_____________________________________________________

 Gender (circle one):         M       F        Date of Birth:_____________________  Age on 9/18/10:_____________

 T-Shirt Size (circle one):      S       M        L        XL

 Read and Sign

In consideration of my acceptance as a participant in the KALB Duck & Run race, I hereby for myself, my heirs, executors and administrators, do waive and release any and all rights and claims for damages I may have against Keep Athens-Limestone Beautiful, Inc., the City of Athens, Alabama, any and all Duck & Run sponsors and any and all parties participating, their agents, representatives and assignees for any and all claims of liability.  I understand there are certain dangers associated with any such athletic event and I certify that I am physically able to compete in this event.

       _____________________________________________________      ________________________________________________________

       Signature of Applicant                                                                         Date        Signature of Guardian (if under 18)                                                          Date