<p> Sponsored by: Registration Form</p><p>Runner ______Walker ______</p><p>Last Name First Name </p><p>Mailing Address </p><p>City State Zip Code </p><p>Birthday / / Age Circle One: Male Female</p><p>E-mail Address: </p><p>Shirt Size (circle one) Adult: S M L XL 2XL 3XL Youth: S M (Shirt guaranteed for all participants registered prior to January 1, 2015)</p><p>$______Adult - Registered prior to January 1, 2015 ($20.00) $______Adult - Registered AFTER to January 1, 2015 ($25.00) $______Student - Registered prior to January 1, 2015 ($15.00) $______Student - Registered AFTER to January 1, 2015 ($20.00) $______Stay in Bed Donation ($20.00) $______- Total Due</p><p>Checks Payable to: Cypress Lake Band Boosters Inc.</p><p>Waiver of Liability Release form is mandatory. Incomplete or unsigned entry forms cannot be accepted. The race will be run rain or shine; no refunds, please. Hot and humid conditions may exist; drink plenty of fluids before and after the race. In consideration of my entry being accepted, I intend to be legally bound, and hereby for myself, my heirs, and executors, waive all rights and claims for damages which may hereafter accrue to me against the sponsors, CLHS Band Boosters Inc., School District of Lee County, officials, volunteers, and all damages or injuries which may be sustained and suffered by me in consideration of my association with an entry or participation in the Edison National Bank Cypress Sprint for Music 5K. If I should suffer injury or illness, I authorize the officials of the race to use their discretion to have me transport to a medical facility, and I take full financial and legal responsibility of this action. I hereby grant full permission to any and all of the foregoing to use any photographs, videotapes, or any other record of this event for any purpose of the event whatsoever. I attest that I am physically fit and have trained sufficiently for the completion of this event. I attest that I am informed of the danger of running in hot humid weather.</p><p>Signature of Runner/Walker or Parent/Guardian of those under 18 Date</p><p>Return this form to 3D Racing/The Run Shoppe 1407 Cape Coral Parkway E, Cape Coral, FL 33904 Phone: (239) 540-9529 www.3dracing.com</p>