Presented by Kaimont LLC
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| Presented by Mercy Center Foundation U.S.A.
| GEORGETOWN HALF MARATHON MAIL-IN ENTRY FORM
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| SHF (Safety And Health Foundation) 611 South Ivy Street, Arlington VA 22204-2429 By entering this event, I agree, warrant and covenant as follows: I know that running is a potentially hazardous activity. I should not enter or run in competitive runs 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 run. I assume all risks associated with running in this race including, but not limited to, CONTRACTION OF DISEASE INCLUDING COVID-19, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release National Park Service, RRCA, USATF, Kaimont LLC, Mercy Center Foundation U.S.A, DC Capital Striders, Safety And Health Foundation, and all sponsors, their directors, officers, employees, agents; 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. I acknowledge that the application fee is non-refundable. I agree that you may use my name and likeness for publicity purposes.
Date __ __-__ __-__ __ __ __ Signature ___________________________________
(parent or guardian if under 18) Name ____________________________________________________________ M | F __ Age on 10/09/2021 __ __ Address ____________________________________________________________ Birthdate ____ ____-____ ____-____ ____ ____ ____ (mm-dd-yyyy) City ____________________________________________________________ ST ___ ___ ZIP ____ ____ ____ ____ ____-____ ____ ____ ____ E-mail ____________________________________________________________________________ Phone ___ ___ ___-___ ___ ___-___ ___ ___ ___ T-shirt (XS S M L XL XXL) _____ Best 13.1-mile time ____:__ __ When/Where? _____________________________________________________ Enclosed is my entry fee, payable to SHF: [_] $50 on or after January 1, 2021 [_] $60 on or after March 1, 2021 [_] $70 on or after May 1, 2021 [_] $80 on or after July 1, 2021 [_] $90 on or after September 1, 2021 [_] $100 on or after October 1, 2021 No race-day registration, please You may take a $10 discount for: [_] Active Duty Military or StudentsPlease make your donation check separate from your entry fee. We recognize all corporate and leading sponsors on our web page |