DYAB KAPAMILYA RUN
OFFICIAL ENTRY FORM
June 13, 2010ASIATOWN IT PARK ASSEMBLY TIME: 4:45 AMRACE STARTS AT: 5:30 AMEARLY BIRD REG: PHP 200 – JUNE 1 to JUNE 7, 2010REGULAR REG: PHP 250 – June 8 to 11LATE REG: PHP 300 – June 12 to 13CATEGORY: 1.6 KM 7 KM 15 KMSINGLET SIZE: SMALL____ MEDIUM____ LARGE____ X-LARGE____
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LAST NAMEFIRST NAME M.I.NATIONALITY
ADDRESS: NUMBER, STREET, CITY, PROVINCE
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DATE OF BIRTHAGESEXTEAM/CLUB/BRGY.CONTACT NUMBER
WAIVER OF LIABILITY
By signing the Entry Form and participating in the DYAB KAPAMILYA RUN, I agree to abide by the rules of thisevent and certify that I am fully and physically fit and adequately trained to finish the race and that I fullyaccept the following Waiver of Liability: I understand that participating in this event may involve real risk of serious injury or even death from various causes including but not limited to falls, over exertion, dehydration,contact with other participants, spectators, road users, effect of weather and conditions of the road. Ivoluntarily assume all risk associated with my participation in the event or any activity associated with it. I, inconsideration of and as a condition of the acceptance of this entry for myself, my executors, administrators,heirs, next of kin hereby waive, release and forever discharge the event organizers, sponsors, promoters,agents or servants from all claims, actions or damages that I may have against them howsoever cause, arisingout of or in any way connected with my participation in this event. I authorize the use of my name, voice andpicture and any information provided by myself on this entry form to be used without payment in anybroadcast, telecast, promotion or advertising. I also agree that the information that I have provided may beused by the event organizer for the purpose of promoting future and other events for the promotion of facesponsors, products and services.
Signature over Printed Name____________________________Date ______________ Parent /Guardian Signature (if under 18) _______________________________
Registration fee includes Singlet, Race #, Route map, & snacksRegistration Center: Abellana Sports center, Runnr Ayala & Holiday Gym & SpaDistribution center: Athletics Dept. Abellana Sports Center: Look for LyleNote: To ensure singlet size, pls. register on or before June 9 afterwhich we cannot guarantee your requested singlet size anymore.
______________________________________________________________________ _________________ LAST NAME, FIRST NAME M.I.CONTACT NUMBER CLUB/COMPANY ______________________________________________________________________ ______________________________ ADDRESS NUMBER, STREET, CITY, PROVINCERECEIVED BY