Registration 2010 Form
Register online and save! United States Air Force Marathon
September 18, 2010
1 CHECK THE EVENT YOU ARE ENTERING
LAST NAME
MARATHON
SUFFIX
HALF MARATHON
FIRST NAME
10K
5K (Sept. 17, 2010)
M.I.
2
STREET ADDRESS/APARTMENT NUMBER
3
4
CITY STATE/PROVINCE
5
ZIP/POSTAL CODE WHEELED MARATHON DIVISION (CHECK ONE)
6
WHEELED 5K DIVISION (CHECK ONE)
7
SEX M/F DATE OF BIRTH
8 11
WHEELED HANDCRANK
WHEELED PUSH RIM
IS THIS YOUR FIRST MARATHON?
9 14 18
WHEELED HANDCRANK
WHEELED PUSH RIM
AGE (ON 9/18/2010)
PREVIOUS AIR FORCE MARATHONS
RACE PERSONAL RECORD
10 16
/
-
/
12 17
13
Yes
No
15
DAYTIME TELEPHONE NUMBER
EVENING TELEPHONE NUMBER
E-MAIL ADDRESS (PLEASE PRINT)
EXPO Registration Amount Enclosed
-
19 AIR FORCE MARATHON GUEST ENTRY FEES
Postmarked by August 31, 2010
20 T-SHIRT SIZE (CIRCLE ONE)
MARATHON & HALF MARATHON MENS S M L XL XXL WOMENS S M L XL XXL
Marathon Marathon 10K 5K Pasta Dinner Adult # # Pasta Dinner Child (6-10) Pasta Dinner Child (5 & under) # Total Amount Enclosed
$90 $75 $45 $30
$100 $85 $55 $35 @ $25 each @ $10 each free
$0.00
10K & 5K S M L XL XXL
21 WAIVER - REQUIRED
In consideration for your accepting my or my child's entry in the United States Air Force Marathon and associated races (including but not limited to the full marathon, the half-marathon, the 10K, the 5K, and the wheelchair races), I, the undersigned, intending to be legally bound, waive and release for myself or my child, my heirs, executor and administrators, any and all rights and claims for damages, demands and any other actions that have resulted from my or my child's participation in the event, which I may have against the United States Air Force, the US Government, the City of Fairborn, Wright State University, Greene County, Montgomery County, MarathonGuide.com/Web Marketing Associates, volunteer medical support, all participating supports and those entities representatives, successors and assignees. I agree to hold these entities, and their agents, representatives, successors, and assignees harmless from any liability including any and all injuries, to include death, that are suffered by me as a result of my participation in this event. I verify I have full knowledge the of rigors of this race and the risk involved in participation, and I am physically fit and have sufficiently trained to complete this event. I realize medical support for this event will consist primarily of volunteer medical personnel prepared to administer first-aid type assistance along the race course and finish line. I acknowledge that MarathonGuide.com/Web Marketing Associates has no responsibility for the operation of the USAF Marathon and associated races and is only acting as an agent to register applicants who wish to participate in the USAF Marathon and associated races and as such does not verify the accuracy and completeness of the information that is provided by the event operators or sponsors. I hereby grant permission to the United States Air Force Marathon and its sponsors to use all information submitted in my or my child's application, and any photograph, videotape, motion pictures, recording and any other record of this event including pre-race and post-race publicity. The registrant agrees to hold MarathonGuide.com/Web Marketing Associates and its agents harmless from any liability or injury resulting from the USAF Marathon and associated races. Furthermore, the registrant agrees that it shall have no claim against MarathonGuide.com/Web Marketing Associates for any injury that may occur during the USAF Marathon and associated races. I understand all confirmed orders are final once payment is submitted. MarathonGuide.com/Web Marketing Associates does not issue refunds.
22 STATUS
ACTIVE DUTY MILITARY (Circle branch of service)
USAF USA USN USMC USCG
CIVILIAN (Non military) RESERVE NATIONAL GUARD
RETIRED MILITARY MILITARY SPOUSE/ DEPENDENT FOREIGN MILITARY
MIL RANK/GRADE ________ MAJOR CMD ______ BASE/POST _______________________________
Mail completed entry form with fee payable by check or money order to:
X
SIGNATURE OF PARTICIPANT DATE
X
SIGNATURE OF PARENT OR LEGAL GUARDIAN - FOR PARTICIPANTS UNDER 18 YEARS OF AGE DATE
USAF Marathon 88 ABW/CVM 5135 Pearson Road, Rm. 252 Wright-Patterson AFB, OH 45433-5319
WAIVER MUST BE SIGNED TO BE PROCESSED
REGISTRATION FEE IS NON-REFUNDABLE AND NON-TRANSERABLE
For more information call 1-800-467-1823 or visit our web site www.usafmarathon.com