Official Entry Form

Official Entry Form

2004 March Into Awareness

Fun Run/Walk

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Last Name First Name MI Sex

Address

______

City State Zip

Daytime Phone Evening Phone

______

Date of Birth Age

Fees are non-refundable. Mail in deadline is 02/28/04.
Please make checks payable to: Minnesota Gastroenterology Colorectal Cancer Fun Run/Walk

Entry fee enclosed

Before 02/28/04 $18 $______
After 02/28/04 $23 $______
Race Day $25 $______
Tax deductible donation $______
Total enclosed $______

Waiver

I agree that if I participate in this physical activity, program or event (the “Event”) or use of any Event facility or Event premises, I do so at my own risk. I agree that I am voluntarily participating in the Event or using Event facilities or premises and assume all risk of injury, illness, damage or loss to me or my property that might result, including, without limitation, any loss or theft of personal property. I hereby consent to receive medical treatment in the event of injury, accident and/or illness during the Event. I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) to release and discharge all Event sponsors and MNGI (and their affiliates, employees, agents, representatives, successors and assigns) from any and all claims or causes of action (know or unknown) arising out of their negligence.

I acknowledge that I have carefully read this Waiver and Release and fully understand that it is a release of liability. By my signature below, I am waiving any right that I may have to bring legal action to assert a claim against MNGI, its parents, subsidiaries and affiliates and all Event sponsors for their negligence.

Signature Date

Parent Signature if participant is a minor Date

When and Where

Join us Saturday, March 6, 2004 at the Lake Harriet Band Shell in Minneapolis. The fun run/walk will begin at 9:00 am.

Strollers and pets are welcome.

Course

The course is an approximate 2.5 miles in length. The fun run/walk will take place on the path around Lake Harriet.

Registration

$18 for entry postmarked by 02/28/04

$23 for entry postmarked after 02/28/04

$25 for event day entry

Make checks payable to Minnesota Gastroenterology Colorectal Cancer Fun Run/Walk

Mail to: March Into Awareness

c/o Peggy Lehman

15805 Nursery Drive

Minnetonka, MN 55345

Event Day

We will begin event day registration and number pick up at 7:30 am, event starts at 9:00 am.

All registered participates are guaranteed a good time, a t-shirt and a blue ribbon on event day. There will be door prize drawings for participants.

Proceeds

All proceeds will go to the Minnesota Colorectal Cancer Consortium.

This registration form may be copied for multiple entries. Feel free to form your own participant teams.