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Ninth Annual Dan Davis Memorial
“Turkey Trot IX” - 5K Run & Walk

Entry Fee before November 1: $20
Entry Fee postmarked after October 31 till race day: $25

Events (check each event in which you will participate)
___ 5K Run & Walk
___ ¼ Mile Kids Fun Run (Kids Run Free)
___ Ghost Turkey (I won’t be trotting but will support the cause)

T-Shirts will be given to all pre-registrants of the 5K Run & Walk. Other registrants (based on availability)

Specify a t-shirt size:
___S ___ M ___ L ___ XL ___ XXL ($2.00 extra)

Age on 11-14-09 ______         Male _____    Female _____

Make checks payable to: The Leukemia & Lymphoma Society
Mail to: Ninth Annual 5K Turkey Trot, 107 WESTPARK BLVD, Suite 150 Columbia, SC 29210

______________________________________________
Name (First, Last)
______________________________________________
Address
______________________________________________
City, State, Zip
______________________________________________
Phone/Email

In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators, and assigns, release and discharge the sponsors and operators of the SC Leukemia & Lymphoma Society's Dan Davis Memorial turkey trot, and their agents and employees from any and all claims for damages suffered by me as the result of my participation in or traveling to or from the said event to be held on November 14, 2009. I specifically release and discharge said operators and sponsors from all injuries or damages arising from or contributed to by any physical impairment or defect I may have, whether latent or patent, and agree that they are under no obligation to provide a physical examination or other evidence of my fitness to participate in such event the same being my sole responsibility. I also give my permission for the free use of my name and picture in any broadcast, telecast or other written account of the event.

______________________________________________________

Athlete’s Signature

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Parent’s Signature (if Athlete is under age 18)

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