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1/2 Marathon Pasco Challenge Registration


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Personalization

* denotes required field

Name*
Address*
City / State / Zip*
Phone*
Email*
Date of Birth *
Age*
Sex*
Running / Cycling Club
T-shirt size (while supplies last. Size guaranteed by February 8) *
How did you hear about the event?*
By submitting this form & payment, I understand & agree to the waiver release and participation of the 2017 Pasco Challenge. PRINT FULL NAME **
tax free

RATES*

 *Includes $2 parking fee levied by park

NO REFUND

In consideration of this entry, I, for myself, my heirs, devises, executors, administrators, and assigns hereby waive, release and discharge any and all claims against, Alzheimer’s Family Organization, organizations, sponsoring or conducting this event or their employees, representatives, or successors, for any and all damage or injuries I may suffer. I certify that I have represented my application for entry that my physical condition and training for this event is adequate to participate safely and I acknowledge that I am familiar with the distances, rigors and risk of the events involved. If I should suffer injury or illness, I authorize the official of the event to use their discretion to have me transported to a medical facility and I take full responsibility for this. I hereby grant permission for the use of my name and picture in any broadcast, brochure, or account of this event.


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