AMERICAN LEGION POST 133 VETERANS RUN NOVEMBER 4, 2017


First Name: ________________________________         Last Name: ______________________________________


Address:__________________________________________________________________________________________


Phone :

List of Runners:

NAME:                                          SEX  M/F              DOB                  T-Shirt Size                                Phone Number
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Emergency Contact:____________________________________________Phone#____________________________

E-mail:_______________________@_________________                                 DOB:__________________________


Payment Method; Check #______ , Cash:______________

Name on Credit Card:------------------------------------------------              Credit Card: Type_____________,

Number:_________________________, Ex Date______________ Code:________

Event Fee            Individual $25.00                 Family (4-6)  $100.00      Family  (7-10)   $150.00

This fee is non-refundable and 100% goes the American Legion and Auxiliary.
Registration Form Agreement:
To the extent allowed by law, I hereby absolve the City of Maricopa, its employees, agents, independent contractors, and officers
from all liability which may arise as the result of my/our participation in activities I or any member of my family attends or registers
into; and in the event that the above participant(s) is a minor, I hereby give my permission for his or her participation as indicated
and in doing so absolve the City of Maricopa, its employees, agents, independent contractors, and officers from such liability. I am
aware that if I have registered for a class involving physical activity, I have taken care to enroll at a class level appropriate to
my/our physical abilities and/or medical condition. I release use of my/our photos taken during program participation from all and
any claims and demands resulting from their use in program publicity.
A signature is required by each adult registering on this form. One participant/guardian may sign for all minors on this account.

Signature:   I agree  typed name                                                                                                                           ,

Date:


Parent Signature (under 18)_  I agree  typed name
Run/Walk
Print copy before submitting
If paying ahead of time and by check or Money Order
mail copy of form along with payment to:

                          American Legion Post 133
                                  P.O. Box 152
                              Maricopa, Az.  85139
If you have any questions contact:
Terry Oldfield at 847-323-4219
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