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Yes! I want to join the fight. Sign me up for the REVLON Run/Walk for Women.
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(if part of mailing address)
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Team name: WIN Against Breast Cancer
Team number: 112
Fees and Divisions (check all that apply)
[] Registration fee $25.00 (includes t-shirt)
[] Late registration fee $30.00 (after 4/28/00)
[] I cannot participate, Please accept my donation of $____________
[] Please call me to volunteer
[] I am a cancer survivor
[] Men's/Women's 5k Run
[] Men's/Women's 5k Walk
[] 12 & under [] 13 - 18 [] 19 - 29 [] 30 - 39
[] 40 - 49 [] 50 - 59 [] 60 - 69 70 & over
T-Shirt size: [] S [] M [] L [] XL
Make checks payable to: REVLON Run/Walk for Women
Mail to: REVLON Run/Walk for Women, C/O Race Central, P.O. Box 828, Rialto, CA 92376
Team number 112 official use: A B C D E F G H I J
WAIVER
With my signature, I acknowledge that running and walking can be inherently strenuous and that no event is without risk. I have consulted my physician regarding my physical capability to participate in this even and am following my physician's advice. I hereby waive all claims against Revlon, The Entertainment Industry Foundation, The Davis Group, all event sponsors and volunteers, the City of Los Angeles, the Los Angeles Memorial Coliseum and any personnel functioning with respect to the event for any injury, accident or physical conditions I might suffer in this event. I grant full permission for organizers to use my name, likeness, or voice and photographs, videotapes, or quotations from me in accounts and promotions in any medium of this event, and of the activities of The Entertainment Industry. This permission is perpetual and worldwide.
Participant name:_______________________ Signature:________________________Date:_______________
(Parent or guardian if under 18)
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