The Cane Event

National Federation of the Blind DOT DASH 8K June 2, 2013

DOT DASH 8K REGISTRATION FORM

$30.00-Before March 31st (Early-Bird Registration)

$35.00-After March 31st

$40.00-Race Day

*First Name: ______

*Last Name: ______

*Gender: Male Female

*Address: ______

*City/State/ZIP: ______

Telephone: ______

*E-mail: ______

*T-Shirt Size: Small Medium Large X-Large XX-Large

*Date of Birth (MM/DD/YYYY)

Only checks will be accepted through paper registration. Please make checks payable to the National Federation of the Blind.

Amount: $______

Signature: ______

Please return completed form and payment to: For more information about this event, National Federation of the Blind please contact: Jernigan Institute DOT DASH 8K Coordinator, Jernigan Institute Attn: DOT DASH 8K Coordinator NATIONAL FEDERATION OF THE BLIND 200 East Wells Street Phone: (410) 659-9314, ext. 2221 at Jernigan Place Fax: (410) 659-5129 Baltimore, Maryland 21230 E-mail: [email protected]

*Required information *I agree to the waiver: (please check the box)

By indicating your acceptance, you understand and agree as follows:

I know that a track and field meet, cross country race, road race, triathlon, adventure race or other endurance event is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the event. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, the effects of weather, including high heat or humidity, traffic and the conditions of the road, and such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone acting on my behalf, waive and release the event organizers and all sponsors, their representatives and successors 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.

1. Authority to Register and/or to Act as Agent. You represent and warrant to Running Maryland You have full legal authority to complete this event registration on behalf of yourself and/or any party you are registering, including full authority to make use of the credit or debit card to which registration fees will be charged. As used in this Agreement and Waiver, Running Maryland and any and all subsidiaries, affiliated entities, or entities that control or are controlled by Running Maryland singly or together and its officers, employees, contractors, subcontractors and agents.

If you are registering a child under the age of 18 or an incapacitated adult you represent and warrant that you are the parent or legal guardian of that party and have the legal authority to enter into this agreement on their behalf and by proceeding with this event registration, you agree that the terms of this Agreement and Waiver shall apply equally to all Registered Parties. By registering a child under 13, you agree and consent to the collection of that child's information which you provide for the purposes of registration.

2. Waiver. You understand that participation in the event is potentially hazardous, and that a registered party should not participate unless they are medically able and properly trained. You understand that events may be held over public roads and facilities open to the public during the event and upon which hazards are to be expected. Participation carries with it certain inherent risks that cannot be eliminated completely ranging in scope from minor to major injuries including death. You understand and agree that in consideration of being permitted to participate in the event, you and any registered party, the heirs, personal representatives or assigns of your or the registered party to hereby release, waive an discharge not to sue any involved parties including Running Maryland for any and all liability from any and all claims arising from participation in the event by you or any registered party. 3. Limitation of Liability; Disclaimer of Warranties. Running Maryland makes no warranty that the Running Maryland site's services will be uninterrupted, secure or free from errors. Running Maryland does not guarantee the accuracy or completeness of any information in or provided in connection with the Running Maryland sites. Running Maryland is not responsible for errors or omissions or the results from the use of such information. Downloading information from Running Maryland is at your own risk and any damage to your computer or loss of data is not the responsibility of Running Maryland. You agree to indemnify and hold harmless Running Maryland from and against all damages, costs, claims, demands, including reasonable attorney fees, made by any third party due to or arising from use of any part of the Running Maryland websites.

By indicating your acceptance of this agreement and waiver, you are affirming that you have read and understand this agreement and waiver and fully understand its terms. You understand that you are giving up substantial rights, including the right to sue. You acknowledge that you are signing the agreement and waiver freely and voluntarily and intend by your acceptance to be a complete and unconditional release of all liability to the greatest extent allowed by law.