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WAIVER AND RELEASE AGREEMENT 5k Circle One 10k PRINT CLEARLY Last Name First Name Gender circle one Male Circle One if applicable Military Female Student Birthdate / / month day year Phone Address Zip City State District/Province Country If not USA Email In Case of Emergency Contact Name Relationship Cell NO REFUNDS FOR ENTRY FEES PLEASE INITIAL 10K Regular 50 / Military/Student 45 5K Regular 40 / Military/Student 35 Payment CASH CHECK AMEXP DISC MC VISA In consider of the acceptance of my...
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