NCCUAA Durham Chapter 5K Walk Registration Form
NCCUAA Durham Chapter 5K Walk: Sat, Oct 13, 2018
Address: NCCU Miller Morgan Building Parking Lot
Registration Start Time: 7:00 am 5K Walk Start Time:8:00 am
Contact us: NCCUDurhamEagles@yahoo.com

All participants must complete a Registration Form.

Email address *
Name *
Your answer
Address *
Your answer
City State Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Gender *
Age on Day of Walk *
Your answer
Emergency Contact *
Your answer
Contact Phone *
Your answer
T-Shirt Size *
Early Registration *
Day of Walk Registration
Release and Waiver (Please Read and Sign (Type Your Name)) I should not enter and walk unless I am medically able. I also know that, although police protection might be provided, there could be traffic on the course route; therefore, I assume the risk of running in traffic. I also assume any other risks associated with running this event including, but not limited to, falls, contact with other participants, and the effects of weather and conditions of the road. I understand I am solely responsible for my own safety while traveling to and from or participating in this event. Knowing these facts and inconsideration of your acceptance of my entry, I hereby for myself, my heirs, executors, administrators, or anyone else who might sue on my behalf covenant not to sue, and waive, release, and discharge the sponsors or contributors to this event, any walk officials, volunteers, the city and police agencies, their representatives successors or assignees from any and all claims of liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of, or in the course of my participation. The release form and waiver extend to all claims of every kind or nature whatsoever, foreseen and unforeseen, known and unknown. The undersigned further grants full permission to use any photographs, video tapes, motion pictures, recordings, or another record of the event for any purpose. Minors will be accepted with a parent’s signature. Signature/Name _____________________________________ *
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Checks Payable: NCCU Alumni Association-Durham Chapter Mail to: Post Office Box 19802 Durham, NC 27707
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