Saturday, March 28, 2009

First Name _______________________ Last Name _____________________________
Date of Birth __/__/____ Age on 03/28/09 __________ Sex 0 M 0 F
Address _____________________________________ City _______________________
State ___________ Zip __________ Email ___________________________________

T-Shirt Size S - M - L - XL -XXL -Youth small -Youth medium

Circle distance you are entering: Tyler Azalea 10k - Azalea 2-Mile Run

I will pick my packet up at: (March 26 & 27 10 a.m. to 7 p.m.) Racquet & Jog Tyler
Tyler's Dallas - Race Day at the event

WAIVER STATEMENT: Entry invalid if not signed. In consideration of the acceptance of this registration entry, I the undersigned assume full and complete responsibility for any injury or accident, which may occur during my participation in the event or while I am on the premises of the event. I hereby release and hold harmless The Tyler Azalea 10k, Mellew Productions, Children's Village, the sponsors, promoters and all other persons and entities associated with the event or their agents or employees, or otherwise. I will not enter and participate unless medically and properly trained. I also know that although police protection will be provided, there may be traffic on the course route. I assume the risk associated with this event, including but not limited to falls, contact with participants, alcohol consumption, the effects of weather including high heat and/or humidity, and the conditions of the road, all such risks being known and appreciated by me. I further grant my permission to use any photographs, videotape, motion pictures, recordings, or any other record of this event. Fees are non-refundable. T-shirt size is not guaranteed. I have read the forgoing and certify my agreement by this signature, and my parent's/ guardian's if under 18.
Signature: X ____________________________________________ Date: _________________
Parent or Legal Guardian Signature, for minor: X ________________________ Date: ________

Mail application with check or money order payable to Mellew Productions at:
The Tyler Azalea 10k
P.O. Box 852856
Richardson, TX 75085