   
Application Form - Run for Ryan 2008
Saturday, September 13
"11th Annual"
This form must be printed and mailed or
dropped off in person to:
(Drop off
between 9:00 AM and 5:00 PM, Monday - Friday)
Porter & Clark Chiropractic
C/O Run for Ryan
29100 Gateway Blvd., Suite 100
Flat Rock, MI 48134
Office: 734-379-9200
Fax: 734-379-9229
Make check or money order payable to:
Flat Rock Ram Boosters
$14 by August
15, 2008
$15 August
15 - September 12, 2008 in person at:
$18 Race Day September
13, 2008 prior to start
of 8K Run or 1 Mile Run/Walk.
| Last Name: |
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| First Name: |
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| Address: |
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| Address2: |
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| City: |
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| State: |
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| U.S. Zip Code or Postal Code: |
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| Age: |
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| Sex: |
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| Birthdate: |
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| Phone: |
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| E-Mail Address: |
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| Distance: |
(Circle one) 8k Run
1 Mile Run |
| Shirt Size: |
(Circle one) M
L XL
XXL |
Signature
(I agree to Waiver below) |
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| Parent's Signature if under 18 years |
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APPLICATION WILL NOT BE PROCESSED WITHOUT SIGNATURE
AND LIABILITY RELEASE.
Waiver: Please accept my entry in the 2008 "Run for Ryan." I, for myself, my
executors, administrators and assignees, do hereby release and discharge the City of Flat
Rock, Flat Rock Ram Boosters, Flat Rock School, "Ryan's Friends", all sponsors,
volunteers and even spectators of the event for all claims of damages, demands, actions
whatsoever in any manner arising from my participation in said event. I attest and verify
that I have full knowledge of the risks involved, I am physically fit, and have my
personal physician's approval. Further, I hereby grant full permission to any and all of
the foregoing to use my photograph, videotape, film, motion picture, or record of my
participation in this event. By signing my name above, I hereby certify that I have read
all the terms and conditions of this release and do intend to be legally bound thereby. |
