2nd Annual Panda Family Fun Run

2nd Annual Panda Family Fun Run
Saturday April 28th, 2007

Mail In Registration Form And Event Information

Make checks payable to:
Providence Elementary
91 E. Center
Providence, Utah 84332

Last Name_____________________________________

First Name_____________________________________

Address_______________________________________

City______________________State________

Zip___________Phone( )_____________________

E-Mail_________________________________________

Gender M F

Race Fee (circle one) Adult Pre Reg. $15.00 Adult same day reg. $20.00

Age on race day: ____ K-12 Pre Reg. $10.00 K-12 Same day reg. $15.00

T-shirt size (circle one) Adult S M L XL XXL ($2.00 extra)

Youth (circle one) XS (2-4) S (6-8) M (10-12)

L (14-16) XL (18-20)

Spaghetti Dinner: #Adults@$7 _______ #of Children3-12@$4 ________

Family of four(2 adults/2children)$20.00 ___________

Total amount enclosed________

_______________________________________________________________________________________________________________

Waiver: In consideration of the acceptance of my entry in the Panda Family Fun Run, I the undersigned participant, or if less than 18 years of age my parent or guardian, intending to be legally bound, do hereby for ourselves, and heirs, executors, administrators and assigns, forever waive, release and discharge any and all rights, claims and actions for damages that we or any of us may have, or that may hereafter accrue to us or any of us, against any and all persons, organizations, and entities associated with the event, including but not limited to, any and all sponsors of the event, cities of Providence, River Heights, Millville, Cache County, the State of Utah, volunteers, and individual race organizers, arising out of or in connections with my entry in, travel to, participation in, and returning from the Panda Family Fun Run. I attest and verify that I am physically fit and sufficiently trained to participate in this event and that I understand that traffic control will end at 9:00 a.m. I also give my permission for the free use of my name and/or pictures in broadcasts, telecasts, newspapers, poster, advertising, etc. I understand that the entry fees are non refundable.

Milliseconds Timing Transponder Instructions: Todays race will be timed using a timing transponder, commonly called the chip. Please follow these simple instructions carefully. Not wearing the transponder properly may prevent you from being timed. Transponders are non-transferable! Be careful not to switch with friends, family, teammates, etc. If the race has multiple distances, participate in the distance for which you are registered. Wrap the ankle bracelet around your left ankle before starting the race, and wear the ankle bracelet around your ankle at all times during the race. Make sure you cross the timing points at the start, intervals (if any), and finish of the race. Return the ankle bracelet to a volunteer in the corral after you cross the finish line. If you still have your ankle bracelet after the race or were not present at the race please put it in a padded envelope and mail to: Milliseconds Sports Timing, 463 West 3600 South, Salt Lake City UT 84115 USA

I agree to return the timing transponder and its attachment device to an appropriate race official after the race. If I fail to do so, I agree to pay $75.00 to replace the timing transponder and attachment device.