Name_________________________________________________________________________
Address________________________________________________________________________
City_____________________________________ State_____________
Zip Code_____________________________________________
Sex: _______Male _______Female
Phone # _____________________________________
T-Shirts (Adult sizes Only) S M L XL
For and in consideration of my participation in the 30th Annual Festival on the Rivers 5 Mile Road Race, Racewalk and Fun Run, the City of Geneva, Geneva County, Alabama Historical Society, Inc., Greater Geneva Area Chamber of Commerce and the Festival on the Rivers Committee, I hereby agree, on behalf of myself, my heirs, executors, administrators and assigns, to indemnify all organizations actively participating in sponsorship of the Run, Racewalk & Fun Run, jointly and severally and hold save harmless from and against any and all actions, claims, demands, liabilities, loss, damage, or expense of whatever kind or nature, including attorney fees, which may at any time be incurred by reason of my participation in the aforesaid race. I do hereby state that I have trained properly and I am physically prepared to run the aforesaid race.
FULL SIGNATURE:__________________________________________________________  (Parent or guardian must sign if under 18) Date___________________________________