Team Relay April 25, 2015 • Louisville, Ky
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ENTRY FORM PAGE 2 MARATHON TEAM RELAY APRIL 25, 2015 • LOUISVILLE, KY April 23-24 April 24 April 25 Race Expo & Packet Pick-Up Running Wild® Pasta Dinner Race Day Post Race Party We are pleased to again offer the Marathon Team Relay in conjunction with the 2015 Kentucky Derby Festival Marathon/ miniMarathon®. This is an exciting way to show your organization’s or group’s true Festival spirit. Come represent WELCOME your organization or group and compete to display the Kentucky Derby Festival Marathon Team Relay trophy. Kentucky Derby Festival Marathon Team Relay Marathon Team Relay Entry Fee Marathon Team Relay “Perks” • 5-Person Team Relay Entry: $300.00 • Official relay medal and poster • Team relay t-shirt Team Relay Awards • Packet pick-up from 4 p.m. – 8 p.m., April 23rd and • The Team Relay has “All Men’s Team,” “All Women’s Team” 11 a.m. – 9 p.m. April 24th, at the Kentucky International and “Coed Team” Divisions Convention Center • Trophies will be awarded to the • Special completion certificates for Team Relay participants top three (3) finishing Teams of each Division in the Marathon Relay Marathon Team Relay Rules and Guidelines • Each Team will consist of up to 5 runners. A Team can have as Marathon Team Relay Registration few as three members competing; however, this will require that Mail-In Registration some Team members run two consecutive legs. For example, if • One Entry Form filled out for each Team a Team has only three members, the first runner may run the • Only one Team per entry form first two legs of the relay and the second runner may run the • Entry Forms may be photocopied next two, while the third runs the final distance to the finish • Entry Forms must have all information line. If a Team has four members, one member must run two complete and payment must accompany form consecutive legs of the relay. • Call 1-800-928-FEST for your Team Relay • All Team members must be registered by the entry deadline of Entry Form March 31, 2015. (Note: Team Relay participants do not fill out • Mail the completed form and fees to: individual entry forms.) Kentucky Derby Festival Marathon Team Relay • Participants can choose to compete on an “All Men’s Team,” 1001 S. Third Street “All Women’s Team” or a “Coed Team.” Louisville, KY 40203 • Each Team will be given one velcro strap timing chip that will be passed from Team member to Team member at each of the For further information about Leg Miles KM relay exchange points. The Team timing chip with the best time the Kentucky Derby Festival First 6.21 10K in each division will be declared the winner. Marathon Team Relay, please • The Relay Team members will run the same course as call 1-800-928-FEST. Second 3.10 5K the Marathon field, under the Ekiden format. See chart Third 6.21 10K to the right. Fourth 3.10 5K Fifth 7.58 12.2K 2015 Kentucky Derby Festival® Marathon Team Relay Official Entry Form Organization Name: Team Name/Number: Choose One: q All Men’s Team q All Women’s Team q Coed Team Includes a $5.00 paper processing fee. All team information must be complete to register. TEAM MEMBER #1 (Team Captain) Race# (If different from team captain) TEAM CONTACT INFO POne Description Price Each Total First Name: Official Use Only First Name: Last Name: Last Name: Marathon Team Relay Entry (Includes a $5.00 paper processing fee.) $305.00 Address: Address: Qty. Extras City: State: Zip: City: State: Zip: Phone Number: Phone Number: Marathon Pin $6.00 E-mail Address (for race information only): E-mail Address (for race information only): sales tax included Birthdate: Age on Race Day: Sex: M q F q Subtotal Estimated Team Finish Time: q Yes, I want my free Pasta Dinner ticket (Hours, Minutes, Seconds) Date Signature of Witness (required) * Total Male Technical Shirt Size: Female Technical Shirt Size: S q M q L q XL q XXL q S q M q L q XL q XXL q *No Refunds By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity TEAM MEMBER #4 Race# and Assumption Agreement. First Name: Official Use Only Last Name: Make check payable to: Kentucky Derby Festival, Inc. Date Signature of Team Member Address: City: State: Zip: TEAM MEMBER #2 Race# Phone Number: WAIVER MUST BE SIGNED TO BE PROCESSED E-mail Address (for race information only): First Name: Official Use Only WAIVER REQUIRED: I know that running a road race is a potentially hazardous activity. I should not enter to run unless I am medically able Last Name: Birthdate: Age on Race Day: Sex: M q F q and properly trained. I assume all risks associated with running this event, including but not limited to: falls, contact with other participants, Address: Estimated Team Finish Time: q Yes, I want my free Pasta Dinner ticket the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry to participate in the City: State: Zip: (Hours, Minutes, Seconds) Male Technical Shirt Size: Female Technical Shirt Size: Derby Festival Marathon / miniMarathon (hereinafter sometimes referred to as the Event) on Saturday, April 25, 2015 (or on such date as may Phone Number: S q M q L q XL q XXL q S q M q L q XL q XXL q be determined in the event of a postponement of the Event) in Louisville, Kentucky, I intending to be legally bound, do hereby for myself, my E-mail Address (for race information only): By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity heirs, my executors and administrators agree as follows: 1. I do waive and forever release any and all rights and claims for any damages and Assumption Agreement. and liabilities of any kind arising out of my participation in the Event against all persons, entities and agencies involved with promoting Birthdate: Age on Race Day: Sex: M q F q the Event, including the Kentucky Derby Festival, Inc.; The Metropolitan Park and Recreation Board; Walmart; Asics; Norton Sports Health; Estimated Team Finish Time: q Yes, I want my free Pasta Dinner ticket Louisville Water Company; Coca-Cola Enterprises; Bluegrass Family Health; Anheuser-Busch; The Courier Journal; Churchill Downs, Inc.; (Hours, Minutes, Seconds) Date Signature of Team Member Active.com; MINI of Louisville; Louisville Metro Government, its officials, executives, employees and agents; Fire Chief, Louisville Division of Male Technical Shirt Size: Female Technical Shirt Size: Fire and their officials; State of Kentucky; and Waterfront Development Corp. their agents, successors, representatives and assigns even S q M q L q XL q XXL q S q M q L q XL q XXL q though that liability may arise out of negligence or carelessness on the part of the persons named in the waiver. 2. Further, I assume the By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity TEAM MEMBER #5 Race# risk of all bodily injuries including death, resulting therefrom and personal injuries to me and damage to and loss of my property, including and Assumption Agreement. loss of use thereof and any other indirect or consequential damages, resulting directly or indirectly, wholly or in part, from my participation First Name: Official Use Only in the Event and while traveling to and from the Event. 3. Further, I hereby agree to indemnify, defend and hold the entities specifically Last Name: named in paragraph numbered 1 above harmless from and against any and all claims, liabilities, losses, damages, costs, expenses, (including Date Signature of Team Member Address: attorney’s fees), judgments and penalties arising out of any of my acts or omission to act. 4. Further, in the event that the participant is a City: State: Zip: person under 18 years of age, the undersigned parent or legal guardian of the participant agrees to indemnify, defend and hold harmless the entities specifically named in paragraph numbered 1 above from and against any and all claims, liabilities, losses, damages, costs, expenses Phone Number: (including attorneys fees), judgments and penalties arising out of the participant’s participation in the Event. 5. Further, I understand that E-mail Address (for race information only): Kentucky Derby Festival, Inc. reserves the right to use any and all participant’s names and/or likenesses with regard to promotional and/ TEAM MEMBER #3 Race# or advertising materials, including on the internet. 6. Further, I understand that all entries are nonrefundable and nontransferable. 7. Race First Name: Birthdate: Age on Race Day: Sex: M q F q Official Use Only officials have the right to disqualify or remove from the course any participant whose activity violates any condition set forth or who poses any Last Name: Estimated Team Finish Time: q Yes, I want my free Pasta Dinner ticket potential harm to himself/herself or any other participant. 8. I am not signing this waiver on behalf of a participant who is under the age of 12. (Hours, Minutes, Seconds) Address: Male Technical Shirt Size: Female Technical Shirt Size: City: State: Zip: S q M q L q XL q XXL q S q M q L q XL q XXL q DATE SIGNATURE OF PARTICIPANT Phone Number: By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity and Assumption Agreement.