Avon Running Entry Form - Kansas City - Sunday October 4

Please print this on your local printer - complete neatly (unclear or incomplete entries will affect results) – mail in with check.

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.

AVON RUNNING - Kansas City (October 4, 1998) WAIVER FORM I know that running/walking is a potentially hazardous activity. I agree not to enter and run/walk 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., Mid-America Running Association, City of Kansas City, MO, Kansas City Parks and Recreation Department, Saint Luke's Hospital, Saint Luke's Shawnee Mission Health System, 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 and entities named in this waiver. I grant permission to all of the foregoing to use my name, likeness and identity in any photographs, motion pictures, recordings or any other record of this event in perpetuity, throughout the world, in any media now known or developed later 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! Why did you take up running or fitness walking? What has it meant to you and your life? Who do you consider your role model?
(For promotional purposes only).
Enclosed is my entry fee:

$15 postmark or in person no later than September 25

$20 September 26-October 3

$10 for any Avon Representative or Associate postmarked no later than September 25

$15 for any Avon Representative & Associate September 26 - October 3

______ Total amount enclosed
NO RACE DAY REGISTRATION

Mail Check & Entry to:

Avon Running - Kansas City
PO Box 481964
Kansas City, MO 64148


For Official Use Only

Bib #

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