Dash at the Dunes Registration Dash at the Dunes Registration Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone**We will only contact you if something unexpected comes up and we would have to change the event date or time. Email* “Early Bird” Drawing I am registering by April 1st, please enter me into the “Early Bird” drawing. Dash at the Dunes RegistrationRegister by April 7th for a reduced Adult fee of $25, Adult fee is $30 beginning April 7th. Children's fee is $10. Includes T-shirt, snacks and drinks at the end of the race and a chance to win a unique Dash at the Dunes wooden medallion.* Adult Child age 12 or under Gender* Male Female Age on Race Day*T-Shirt Size*Youth X-Small (2-4)Youth Small (6-8)Youth Medium (10-12)Youth Large (14-16)Adult SmallAdult MediumAdult LargeAdult XLAdult XXLAdult XXXL*If registered after April 8th, t-shirt availability will be on a first come first serve basis. Emergency Contacts*Please list at least one emergency contact, relationship and phone number. CommentsWAIVER OF LIABILITY AND INDEMNITY AND HOLD HARMLESS AGREEMENT- All persons who wish to participate in the Dash at the Dunes 5K Trail Run/Walk are required to carefully review the following statement and check the box. Please read this carefully. It affects any rights you may have it you are injured and or otherwise suffer damages as a result of participating in said trail run/walk. I acknowledge that I understand that in consideration for my being permitted to participate in said trail run/walk, I do hereby, for myself, the members of my family and spouse in I am alive, and my heirs, assigns and personal representatives if I am deceased, acknowledge and assume the risk of participation in the trail run/walk, and do hereby RELEASE AND FOREVER DISCHARGE Woodland Dunes Nature Center Inc., and all their officers, agents, and representatives or employees, (herein after referred to “Releases”) whether accompanying said trail run/walk or otherwise, from any and all claims, liability, suits, loses, judgments, expenses, damages, costs, demands, actions or causes of action on account of any injury to me or my property or on account of my death which may occur from any cause as a result of or in reference to preparing for, during preparation in and until competition of any action, activities or events in relationship and regard to said trail run/walk, or proceedings at law or in equity or otherwise as provided by law, against any of said entities or persons on account of any and all such claims, liability, suits, loses, judgments, expenses, damages, costs, demands, actions or causes of action. I further AGREE TO INDEMINIFY AND HOLD HARMLESS THE RELEASES from any loss, liability, damage or cost, including court costs and attorney’s fees, which may incur due to my preparing for, participation in and completion of any action, activities or events in relationship and regard to said trail run/walk. In signing this form, I acknowledge and represent that I have read the foregoing Waiver of Liability and Indemnity and Hold Harmless Agreement, understand in and sign in voluntarily as my own, free act and deed; no oral representation, statements, or inducements apart from this written agreement have been made; I am at least eighteen (18) years of age and fully competent (if not eighteen, my parent(s) or guardian(s) agree with the terms in this document); and I execute the Release for full, adequate and complete consideration fully intending to be bound by the same. I have had adequate time to consult with an Attorney and to all aspects of this agreement.*If in agreement of the above terms, type your name and the date in this box. Payment is required in order to complete your registration.* I understand that my registration is NOT complete and will not be accounted for until I have paid in full.