Avon Running Entry Form - Altanta - Saturday April 4

Please print neatly – unclear or incomplete entries will affect results – both pages must be completed.

Sign me up! Choose One: 10K Run 5K Fitness Walk
Last Name First Name M.I.

Street

City State Zip Country

Day Phone Evening Phone E-mail ____________

Date of Birth mm dd yy Age on Race Day T-Shirt Size: S M L XL

Check all that apply:

Wheelchair Participant
Avon Sales Representative -
Account #: ________________
Avon Associate -
Branch: ________________




Mother/Daughter Team* Division - Partner's Name:
First __________ Last ______________________________
Open Team* Division.
Team Name: ______________________________________
Team Captain's Name: ______________________________
Captain's Day Phone Number: ________________________

* Each team member must fill out an individual entry. All entries must be submitted in the same envelope. Team entries must be received by race administration at least one week before race day.

Previous Best 10K Time: hr.min.sec. This is my first walk event.

I know that running/walking is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of an event organizer relative to my ability to safely complete the run/walk. I assume all risks associated with running/walking in this event including, but not limited to: falls, contact with other participants, the effects of the weather, conditions of the course, all risks being known and appreciated by me. 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 Avon Products, Inc., Atlanta Track Club, Oglethorpe University, DeKalb County, Fulton County, Road Runners Club of America 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 the persons named in this waiver. I grant permission to all of the foregoing to use my photographs, motion pictures, recordings or any other record of this event for any legitimate promotional purpose.

________________________________________________ _____________________
Signature (Parent's/Guardian's Signature if under 18 years)Date


Occupation _____________________________

Hometown Newspaper Name: ______________________ City: _____________________
Tell us your story! Have any interesting, motivating, unusual, fun stories to share? We'd like to hear.
(For promotional purposes only).
Enclosed is my entry fee:

$15 postmarked by March 27th

$20 received by April 3rd

$5 discount for any Avon
Representative or Associate

______ Total amount enclosed

Mail Check & Entry to:

Avon Running – Atlanta
Atlanta Track Club
3097 E. Shadowlawn Avenue, NE
Atlanta, GA 30305

For Official Use Only

Bib #

Copy This Form For A Friend. Copies Gladly Accepted



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