2006 MAA Missouri Section 5K Walk / Run Entry Form

Click here for a map of the 5k Walk/Run. The event will take place Saturday, April 1, 2006.

Please print and complete entire form / one person per entry form.

Name_________________________________________________________________________

Address_______________________________________________________________________

City_________________________________________________ State_____ Zip____________

Phone_________________________________

WAIVER: I know that participating in this walk/run is potentially hazardous. I should not enter unless I am medically able and properly trained. I also assume any and all risks associated with this event including but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and the condition of the roads and traffic, all such risks being known and appreciated by me.

Knowing these facts, and in consideration of your accepting my entry, I hereby, for myself, my heirs, executors, administrators, or anyone else who might claim on my behalf, covenant not to sue, and waive, release and discharge the Mathematical Association of America, The Missouri Section of the Mathematical Association of America, University of Missouri, the Curators of the University of Missouri, the State of Missouri, and/or any agents authorized by them for any purpose.

This release and waiver extends to all claims of every kind or nature, whatsoever, foreseen or unforeseen, known or unknown.

Applications for minors are accepted only with a parent / guardian signature.

______________________________________________________________________________
Signature of Participant/Date

______________________________________________________________________________
Parent / Guardian if Participant is under age 18/Date