Crosslake
Dam Run 10k and 5k
Official Entry and Release Form
Name_________________________
Age on race day:____
Address___________________________
City,
State_________________________ Shirt size: SM__ M__ L__ XL___
Zip______ Phone(___)_______Entry 10k__ 5k__ Date of Birth______
RELEASE: In consideration of the acceptance of my entry, I, the undersigned, intending to be legally bound for myself, my Heirs, Executors, and Administrators, do hereby release any and all sponsors of this race, and their representatives, successors, and assistants from any and all liability arising from illness or injuries I may suffer as a result of my participation in this race. I also understand and agree that any sponsor may subsequently use for publicity and/or promotional purposes my name and/or photographs of me participating in this even without obligation or liability to me. I also understand that entry fees I pay are not refundable. I have read the foregoing and certify my agreement by my signature below.
(ParticipantŐs signature or signature of parent or guardian if participant is under 18)
$20.00 before Aug. 1st. $25.00 After July 31 until race day. Checks payable to "Crosslake Dam Run" Mail to: Mick Justin P.O. Box 90 Pequot Lakes, MN, 56472
