Please Fill Out and sign waiver.  Copy and Paste form to e-mail and send to CLYTC FITNESS DIRECTOR, Mel Corporon

CLYTC 2008 RUNNING CLUB

NAME: _______________________________________________________

AGE _________

DATE OF BIRTH: _____________    SEX:   ___MALE     ___FEMALE

ADDRESS: _____________________________________________________

CITY: ________________________ STATE: _____ ZIP: _________________

E-MAIL: _______________________________________________________

DAY PHONE:____________________________________

T-SHIRT SIZE (cost is a $5 extra fee):  ___ S      ___ M     ___ L     ___ XL    

WAIVER: Entry invalid if not signed.  In consideration of the acceptance of this registration entry, I, the undersigned, assume full and complete responsibility for any injury, accident or nuisance may occur to me during the event or while I am on the premises of the event.  I hereby release and hold harmless Chandlers Landing Yacht and Tennis Club, Chandlers Landing Yacht and Tennis Club  Event Coordinator and staff and volunteers, Chandlers Landing Community Association, any of the sponsors, promoters and all other persons and entities associated with the event or their agents or employees or otherwise.  I will not enter and participate unless medically able and properly trained.  I also know that police protection, medical emergency response team or road monitors may not  or may be provided.  I also know that there may be traffic on the course route.   I assume the risk associated with this event, including but not limited to falls, contact with other participants, the effects of weather, and the conditions of the road.   Fees are non-refundable.  T-shirt’s are extra cost and not included in registration fee.   I have read the foregoing and certify my agreement by this signature, and my parent's or guardian's if under age 18.

________________________________                 _____________________

                     SIGNATURE                                                    DATE