Last Name, First Name:
Street Address:
City, State, Zip:
Day Phone:
E-mail:
Race Day Age:
Entry Fee
Please Make Checks Payable to: The United Blood Services, P.O. Box 61650, Midland, TX 79711
Release Form: I fully understand that running
a road race is a potentially hazardous activity. I should not enter unless I
am medically able and properly trained. I assume all risks associated with running
in this event including, but not limited to: falls, contact with other participants,
the effects of the weather, including high heat and/or humidity, traffic and
conditions of the road, all risks being known and appreciated by me. Having
read this waiver and knowing these facts and in consideration of you accepting
my entry, I for myself and anyone entitled to act on my behalf, hereby waive
and release the Bloodgusher Runs, Scharbauer Sports Complex, the Permian
Basin Running Club, the United Blood Services, its officers and agents, the
City of Midland, all sponsors, their representatives and successors involved
in the Bloodgusher Runs from all claims or liabilities of any kind arising
out of my participation in this event even though that liability may arise out
of negligence or carelessness on the part of the persons named in this waiver.
Signature______________________________________________ date____________________
(parent signature
if minor)