Spa10 K 2008
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 12/31/08____ DOB__/__/__ Sex M_ F_
__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/
10 K/5 K Adult Sizes (Circle one) SM M L XL
Spa Squirt (Circle one) Youth Sizes SM M
VESTS
Only guaranteed for the first 600 registrants
SIZES XXS XS S M L XL
WAIVER (all participants must sign) SIGNATURE OF PARENT/LEGAL GUARDIAN IF CHILD
IS UNDER 18
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
______________________________________________________________
DATE ____________
