Ashley's Run 5K Run/Walk 
March 20, 2010, 9 a.m.
Powder Springs, GA

OFFICIAL ENTRY FORM – PLEASE PRINT

Check amount $________Payable to Ashley's Run & mail to PO Box 394, Powder Springs, GA 30127

[ ] Phantom Runner: I am unable to participate but would like to support the event and get my t-shirt (minimum $20 please)

$20 if registered by March 10, 2010. Late registration and race day = $25

T-Shirt: [ ] S [ ] M [ ] L [ ] XL [ ] 5K Run [ ] 5K Walk

NAME ______________________________________________________________ AGE ___________

ADDRESS __________________________________________________________________________

CITY/STATE/ZIP _________________________________________________GENDER [ ] M [ ] F

E-MAIL _____________________________________________ PHONE ________________________

Waiver I know that running a road race is a potentially hazardous activity. I am in proper physical condition to complete this run/walk and assume all risks associated with my participation including, but not limited to, falls, contact with other participants, and the effects of the weather, including high heat and/or humidity, traffic, conditions of the road, all such risks being known and appreciated by me. I will not wear headsets or any device that restricts my hearing or other perception. In consideration of this entry, for myself and anyone entitled to act on my behalf, I waive and release all race officials, volunteers, sponsors, and any others associated with this event. Furthermore, I hereby grant the agents of this event permission to use photographs, videotapes, motion pictures, recordings or any other record of me in this event for legitimate purposes.

_______________________________________________________________________________ _____________________

Signature of participant /Parent or guardian's signature if under 18 years of age ...................................................... Date