Print this form, fill it out and mail to:
Spa10 K 2007
P.O. Box 8101
Hot Springs Village, AR. 71910

Here's My Info
Name (First/Last)____________________________________________________________
Address_____________________________________________________
City/State/Zip________________________________________________
Day Phone (___)_________Night Phone(__ )_____________
Email _______________________
Age (at years end 12/31/07____  DOB__/__/__ Sex M_ F_
 
SIGN ME UP: (Check Only for one event)
__SPA 10 K - $30.00 (through Nov. 14th)  ($35.00 onsite registration)
__SPA 5 K -  $30.00 (through Nov. 14th)  ($35.00 onsite registration)                      
__SPA SQUIRT - $20.00 (pre or same day registration, no late fee)
 
SAVE ME A SHIRT/  *Jackets limited to first 500 entrants
10 K/5 K Adult Sizes (Circle one) SM M L XL 2X
Spa Squirt Youth Sizes (Circle one)  M  Adult S

WAIVER (all participants must sign)
 

In consideration of acceptance of this entry, I waive any and all claims for myself
and my heirs against volunteers, officials, sponsors or affiliated organizations of
the Spa 10 K, Spa 5 K, and the Spa Squirt for injury or illness which may directly
or indirectly result from participation. I further state that I am in proper physical
condition to participate in these events. I also give permission for the free use of
my name and/or picture in account of this event.

______________________________________________________________
                                                    

signature

  
______________________________________________________________

SIGNATURE OF PARENT/LEGAL GUARDIAN IF CHILD IS UNDER 18
DATE ____________