ENTRY FORM PAGE 2 TEAM CHALLENGE PRESENTED BY APRIL 19, 2014 • LOUISVILLE, KY April 17-18 April 18 April 19 Race Expo & Packet Pick-Up Running Wild® Pasta Dinner Race Day Post Race Party miniMarathon Team Challenge Marathon Team Challenge miniMarathon Team Challenge “Perks” Marathon Team Challenge “Perks” • Official miniMarathon Team Challenge T-shirt, finisher’s medal and poster • Official Marathon Team Challenge shirt, finishers’ medal and poster. • Express packet pickup from 11 a.m. – 7 p.m., April 17th, and • Express packet pickup from 11 a.m. – 7 p.m., April 17th, and 11 a.m. – 9 p.m., April 18th, at the Kentucky International 11 a.m. – 9 p.m., April 18th, at the Kentucky International Convention Center Convention Center • Complimentary Pasta Dinner Tickets for each member of your Team • Complimentary Pasta Dinner Tickets for each member of your Team upon request (you can order more if you like) upon request (you can order more if you like) • Special completion certificates for Team Challenge participants • Special completion certificates for Team Challenge participants • Hospitality at Waterfront Park in Runner’s Reunite Area following the Race • Hospitality at Waterfront Park in Runner’s Reunite Area following the Race miniMarathon Team Challenge Rules and Guidelines Marathon Team Challenge Rules and Guidelines • All members on the Team Challenge entry must be at least 18 years • All members on the Team Challenge entry must be at least 18 years of age as of race day, April 19, 2014 of age as of race day, April 19, 2014 • All Team members must be registered by the entry deadline of • All Team members must be registered by the entry deadline March 31, 2014 (NOTE: Team Challenge participants do not fill out of March 31, 2014 (NOTE: Team Challenge participants do not fill out individual entry forms!) individual entry forms!) • Each Team must have at least four (4) but no more than five (5) members • Each Team must have at least three (3) members and is allowed up to five (5) • At least four (4) members of the Team must participate and each must members per Team complete the miniMarathon • At least three (3) members of the Team must participate and each must • Participants competing in the corporate division of the Team Challenge complete the full Marathon MUST be employees of the company they are representing • Participants competing in the corporate challenge MUST be employees of the • Employment must be verifiable or the Team will be disqualified company they are representing • All other groups or clubs may compete in the Open division of the • Employment must be verifiable or the Team will be disqualified Team Challenge • All other groups or clubs may compete in the Open division of the • Team Challenge results are computed by accumulating a Team’s four Team Challenge (4) fastest out of a possible five (5) finish times. Team with the fastest • Team Challenge results are computed by accumulating a Team’s three (3) fast- accumulated time in each division will be declared the winner est out of a possible five (5) finish times. The Team with the fastest accumu- • The top three Teams in each division will receive awards lated time in each division will be declared the winner • The top three Teams in each division will receive awards miniMarathon Team Challenge Entry Fees • Corporate and Open Team Challenge Entry Fees: $375.00 Marathon Team Challenge Entry Fees • Corporate and Open Team: Marathon and miniMarathon Team Challenge Team of three (3) $300 Registration Mail-In Registration Team of four (4) $400 • One Entry Form filled out for each Team Team of five (5) $475 • Only one Team per entry form Team Challenge Awards • Entry Forms may be photocopied • Entry Forms must have all information complete • The Team Challenge has both a Corporate and an Open Division. and payment must accompany form • Trophies will be awarded to the top three (3) finishing Teams of each Division • Call 1-800-928-FEST for your Team Challenge entry form in both the Marathon and miniMarathon • Mail the completed form and fees to: Derby Festival Marathon Team Challenge For further information about the Kentucky Derby Festival 1001 S. Third Street Marathon/miniMarathon Team Challenge, Louisville, KY 40203 please call 1-800-928-FEST. 2014 Kentucky Derby Festival® Marathon/miniMarathon® Team Challenge Official Entry Form Organization Name: Team Name/Number: Remember to check the boxes for your free Pasta Dinner tickets. Choose One: q Open Division q Corporate Division (All participants must be employees of company represented) All team information must be complete to register. TEAM MEMBER #1 (Team Captain) Race# TEAM MEMBER #4 Race# POne Description Price Each Total Last Name: Official Use Only Last Name: Official Use Only First Name: First Name: miniMarathon Team Entr $375.00 Address: Address: Marathon Team of Three (3) $300.00 City: State: Zip: City: State: Zip: Phone Number: Phone Number: Marathon Team of Four (4) $400.00 E-mail Address (for race information only): E-mail Address (for race information only): Marathon Team of Five (5) $475.00 Birthdate: Age on Race Day: Sex: M q F q Birthdate: Age on Race Day: Sex: M q F q Qty. Extras Estimated Finish Time: q Yes, I want my free Pasta Dinner ticket Estimated Finish Time: q Yes, I want my free Pasta Dinner ticket (Hours, Minutes, Seconds) (Hours, Minutes, Seconds) Male Technical Shirt Size: Female Technical Shirt Size: Male Technical Shirt Size: Female Technical Shirt Size: Pasta Dinner Ticket - Adult (12 and over) $9.00 S q M q L q XL q XXL q S q M q L q XL q XXL q S q M q L q XL q XXL q S q M q L q XL q XXL q Pasta Dinner Ticket - Child (under 12) $6.00 By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity and Assumption Agreement. and Assumption Agreement. Marathon Pin $6.00 miniMarathon Pin $6.00 Date Signature of Team Member Date Signature of Team Member Paper application processing fee $3.00 sales tax included TEAM MEMBER #2 Race# TEAM MEMBER #5 Race# Subtotal Last Name: Last Name: Official Use Only Official Use Only * Total First Name: First Name: Address: Address: *No Refunds City: State: Zip: City: State: Zip: Phone Number: Phone Number: E-mail Address (for race information only): E-mail Address (for race information only): Make check payable to: Kentucky Derby Festival, Inc. Birthdate: Age on Race Day: Sex: M q F q Birthdate: Age on Race Day: Sex: M q F q Estimated Finish Time: q Yes, I want my free Pasta Dinner ticket Estimated Finish Time: q Yes, I want my free Pasta Dinner ticket WAIVER MUST BE SIGNED TO BE PROCESSED (Hours, Minutes, Seconds) (Hours, Minutes, Seconds) Male Technical Shirt Size: Female Technical Shirt Size: Male Technical Shirt Size: Female Technical Shirt Size: 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 S q M q L q XL q XXL q S q M q L q XL q XXL q S q M q L q XL q XXL q S q M q L q XL q XXL q and properly trained. I assume all risks associated with running this event, including but not limited to: falls, contact with other participants, By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and and Assumption Agreement. and Assumption Agreement. appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry to participate in the Derby Festival Marathon / miniMarathon (hereinafter sometimes referred to as the Event) on Saturday, April 19, 2014 (or on such date as may 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 Date Signature of Team Member Date Signature of Team Member 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 liabilities of any kind arising out of my participation in the Event against all persons, entities and agencies involved with promoting the Event, including the Kentucky Derby Festival, Inc.; The Metropolitan Park and Recreation Board; Walmart; Asics; Norton Sports Health; Louisville Water Company; Coca-Cola Enterprises; Bluegrass Family Health; Anheuser-Busch; The Courier Journal; Churchill Downs, Inc.; Active.com; UPS; TEAM MEMBER #3 Race# TEAM CONTACT INFO (If different from team captain) MINI of Louisville; Louisville Metro Government, its officials, executives, employees and agents; Fire Chief, Louisville Division of Fire and their officials; State of Kentucky; and Waterfront Development Corp. their agents, successors, representatives and assigns even though that liability Last Name: Official Use Only Last Name: First Name: First Name: may arise out of negligence or carelessness on the part of the persons named in the waiver. 2. Further, I assume the risk of all bodily injuries including death, resulting therefrom and personal injuries to me and damage to and loss of my property, including loss of use thereof and any Address: Address: other indirect or consequential damages, resulting directly or indirectly, wholly or in part, from my participation in the Event and while travel- City: State: Zip: City: State: Zip: ing to and from the Event.