Survivor's Challenge 5K
Fort Smith , AR
May 17, 2008
8:00 AM
Arkansas Grand Prix RRCA Racing Series
ENTRY FORM - PLEASE PRINT Grand Prix Website: www.ArkRRCA.com
Name: Last: First:
Date of Birth: Age on May 17, 2008:
Sex:     M       F
Address:
City, State, ZIP:
Check One:             ____5K Runner              ____5K Wheelchair              ____2 Mile Wellness Walker
Shirt Size:         S              M              L              XL              XXL
Release:
In signing this form, I understand and agree to absolve and hold harmless the sponsors, all officials, and all other persons and entities at this event of all blame for any injury, harm, loss, or inconvenience that may directly or indirectly result from my participation in said event. I further state that I am in proper physical condition to participate in said event. I also understand and agree that my entry fee is non-refundable. I give the Celebrity Classic and the Cancer Support House full permission to use photographs including my image or likeness for marketing or for other reasonable purposes. If you have any questions, call the Cancer Support Foundation at 479-782-6302.
Signature:
Parent Signature if under 18 years old:
Date:
Entry Fee: $15 preregistered; $20 on Race Day
Family Rate: $10 each for a family of 4 or more

Make checks payable to The Celebrity Classic and mail to:
Cancer Support Foundation
3324 South M Street
Fort Smith, AR 72903