Running Club @ UW-Madison Fall 15K

Race Registration Form

Print this page and mail the completed form to:

Running Club @ UW-Madison
c/o Ron Carda
2000 Observatory Drive
Madison, WI 53706

Registration fees (checks payable to Running Club @ UW-Madison)
Individuals:  $13 before October 20, $17 after including race day.
Relay Teams: $39 before October 20, $51 after including race day
Please complete one form for each entrant. Photocopies are accepted.
Pre-Registration Mailing Deadline: Postmarked October 20nd

Name:_______________________________

Address:____________________________________

City/State/Zip:________________________________

Daytime Phone:__________________ Evening Phone:_____________________

Email address:____________________________

Age:_______              Sex:    ___ male    ___ female

Circle One:   15K Run / 15K Relay
Make registration checks payable to: Running Club@UW-Madison. Sorry, no refunds.

**Note: The relay race consists of a three (3) member team, with each member running a 5k leg.

Relay member names if applicable:

____________________________________    _____________________________________

Waiver - I understand that running is a potentially hazardous activity. I shouldn’t enter unless I’m medically able and properly trained. I assume all risks associated with running in this event. Having read this waiver and accepting my entry, I, for myself or anyone entitled to act on behalf, waive and release the University of Wisconsin-Madison, the UW Running Club, the City of Madison and Dane County, WI from all claims or liabilities of any kind arising out of my participation in this event.

Signature:___________________________________  Date:______________
If under 18, parent’s signature must accompany.
See website (http://uwrc.net/Fall15k) for more info.