Name ___________________________________________________ 

Address ________________________________________________ 

City __________________________ State _____Zip _________ 

Phone _____________________ E-Mail _____________________ 

Sex: __ M	__ F	     Race Day Age______Birthdate_________

T-Shirt Size:  S   M   L   XL   XX
Size Not Guaranteed for entries
Received after June 15th

Check One: ___ 5K ___ 12K

Runner Pancake Breakfast (optional) $5.00: Yes / No
Additional Pancake Breakfast(s) (optional) $6/ea.: QTY___

Registration Fees:

• 5K - $20.00 before July 2nd
• 5K - $25.00 Race Day
• 12K - $25.00 before July 2nd
• 12K - $30.00 Race Day

Send completed entry and make check payable to:
Racing Underground, P.O. Box 7042, Golden, CO 80403.

Entries will not be taken by phone or fax. Please see our refund policy regarding refunds and transfers of entry.

Waiver Statement:

I acknowledge that this athletic event is an extreme test of a person's physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating &/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwide by a qualified medical person. I acknowledge that the Accident Waiver and Release of Liability form will be used by the event holders, sponsors and organizers of the event in which I may participate, and that it will govern my actions and responsibilities at said events. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Darrin & Jill Eisman, Racing Underground llc, Boulder County, Jefferson County, CCCIA, their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liailities or claims made as a result of participation in this event, whether caused by the negiligence of releases or otherwise. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and assigns. The Accident Waiver and Release of Liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document; and, I understand it's content. PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old) The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.

Signature __________________________ Date _______
Signature of Parent or Guardian________________Date _________
(if under 18 years old, Parent or guardian must also sign)