REGISTRATION FORM
make checks payable to L.B.E.F. and mail to
J & J Sports Production
P.O. Box 3215
Auburn, CA 95604
Last Name___________________________First Name________________________
Address________________________________________________________________
City_________________________State_______________Zip_____________________
Phone ( )__________________________E-Mail______________________________
Birthdate____________Sex_____________Distance_________________________
Only pre-registrants will be guaranteed a t-shirt
Adult: Small( ) Medium( ) Large( ) X-Large ( ) XXL ( )
Youth: Small( ) Medium( ) Large( )
AGREEMENT, WAIVER & RELEASE
I agree to indemnify and hold harmless the Loomis Basin Education Foundation, Manda RUN Committee members, J & J Sports Productions and/all co-sponsoring agencies and subcontractors from any and all liability for injuries and damages which may arise as a result of my participation in this activity. I further agree that the Loomis Basin Education Foundation representatives, Manda RUN committee members, J & J Sports Productions, and volunteers may act in an emergency as best fits the situation in the event I or an emergency contact cannot be reached. I am aware that the sponsoring organizations do not carry medical insurance for participants in this activity and that I hereby affirm I am in proper physical condition to participate in the Manda RUN.
SIGNATURE________________________________________DATE____________ PARENT/GUARDIAN IF UNDER18____________________________________