ENTRY FORM PAGE 2
TEAM CHALLENGE
A P R I L 2 5 , 2 015 • L O U I S V I L L E , K Y
April 23-24
April 24
April 25
Race Expo & Packet Pick-Up
Running Wild® Pasta Dinner
Race Day Post Race Party
miniMarathon Team Challenge
Marathon Team Challenge
miniMarathon Team Challenge “Perks”
• Official miniMarathon Team Challenge T-shirt, finisher’s medal and poster
•Packet pick-up from 4 p.m. – 8 p.m., April 23rd, and 11 a.m. – 9 p.m., April
24th, at the Kentucky International Convention Center
•Complimentary Pasta Dinner Tickets for each member of your Team
upon request (you can order more if you like)
• Special completion certificates for Team Challenge participants
• Hospitality at Waterfront Park in Runner’s Reunite Area following the Race
Marathon Team Challenge “Perks”
• Official Marathon Team Challenge shirt, finishers’ medal and poster.
• Express packet pick-up from 4 p.m. – 8 p.m., April 23rd, and
11 a.m. – 9 p.m., April 24th, at the Kentucky International
Convention Center
• Complimentary Pasta Dinner Tickets for each member of your Team
upon request (you can order more if you like)
• Special completion certificates for Team Challenge participants
• Hospitality at Waterfront Park in Runner’s Reunite Area following the Race
miniMarathon Team Challenge Rules and Guidelines
• All members on the Team Challenge entry must be at least 12 years
of age as of race day, April 25, 2015
• All Team members must be registered by the entry deadline of
March 31, 2015 (NOTE: Team Challenge participants do not fill out
individual entry forms!)
• Each Team must have at least four (4) but no more than five (5) members
• At least four (4) members of the Team must participate and each must
complete the miniMarathon
• Participants competing in the corporate division of the Team Challenge
MUST be employees of the company they are representing
• Employment must be verifiable or the Team will be disqualified
• All other groups or clubs may compete in the Open division of the
Team Challenge
• Team Challenge results are computed by accumulating a Team’s four
(4) fastest out of a possible five (5) finish times. Team with the fastest
accumulated time in each division will be declared the winner
• The top three Teams in each division will receive awards
miniMarathon Team Challenge Entry Fees
• Corporate and Open Team Challenge Entry Fees: $375.00
Marathon and miniMarathon Team Challenge
Registration Mail-In Registration
• One Entry Form filled out for each Team
• Only one Team per entry form
• Entry Forms may be photocopied
•Entry Forms must have all information complete
and payment must accompany form
• Call 1-800-928-FEST for your Team Challenge entry form
•Mail the completed form and fees to:
Derby Festival Marathon Team Challenge
1001 S. Third Street
Louisville, KY 40203
Marathon Team Challenge Rules and Guidelines
•All members on the Team Challenge entry must be at least 16 years
of age as of race day, April 25, 2015
• All Team members must be registered by the entry deadline
of March 31, 2015 (NOTE: Team Challenge participants do not fill out
individual entry forms!)
•Each Team must have at least three (3) members and is allowed up to five (5)
members per Team
•At least three (3) members of the Team must participate and each must
complete the full Marathon
•Participants competing in the corporate challenge MUST be employees of the
company they are representing
• Employment must be verifiable or the Team will be disqualified
• All other groups or clubs may compete in the Open division of the
Team Challenge
•Team Challenge results are computed by accumulating a Team’s three (3) fastest out of a possible five (5) finish times. The Team with the fastest accumulated time in each division will be declared the winner
• The top three Teams in each division will receive awards
Marathon Team Challenge Entry Fees
•Corporate and Open Team:
Team of three (3): $300
Team of four (4): $400
Team of five (5): $475
Team Challenge Awards
•The Team Challenge has both a Corporate and an Open Division
•Trophies will be awarded to the top three (3) finishing Teams of each Division
in both the Marathon and miniMarathon
For further information about the Kentucky Derby Festival
Marathon/miniMarathon Team Challenge,
please call 1-800-928-FEST.
(Hours, Minutes, Seconds)
Age on Race Day:
Sex: M q F q
q Yes, I want my free Pasta Dinner ticket
State:Zip:
Official Use Only
Race#
(Hours, Minutes, Seconds)
(Hours, Minutes, Seconds)
Date
Signature of Team Member
Female Technical Shirt Size:
Male Technical Shirt Size:
S q M q L q XL q XXL q
S q M q L q XL q XXL q
By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity
and Assumption Agreement.
State:Zip:
Official Use Only
Race#
Age on Race Day:
Sex: M q F q
q Yes, I want my free Pasta Dinner ticket
TEAM MEMBER #3
Signature of Team Member
First Name:
Last Name:
Address:
City:
Phone Number:
E-mail Address (for race information only):
Birthdate:
Estimated Finish Time:
Date
Female Technical Shirt Size:
Male Technical Shirt Size:
S q M q L q XL q XXL q
S q M q L q XL q XXL q
By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity
and Assumption Agreement.
State:Zip:
Official Use Only
Race#
Age on Race Day:
Sex: M q F q
q Yes, I want my free Pasta Dinner ticket
TEAM MEMBER #2
Signature of Team Member
First Name:
Last Name:
Address:
City:
Phone Number:
E-mail Address (for race information only):
Birthdate:
Estimated Finish Time:
Date
Female Technical Shirt Size:
Male Technical Shirt Size:
S q M q L q XL q XXL q
S q M q L q XL q XXL q
By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity
and Assumption Agreement.
Team Name/Number:
State:
(Hours, Minutes, Seconds)
Date
Signature of Team Member
Female Technical Shirt Size:
Male Technical Shirt Size:
S q M q L q XL q XXL q
S q M q L q XL q XXL q
By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity
and Assumption Agreement.
State:Zip:
Official Use Only
Race#
Age on Race Day:
Sex: M q F q
q Yes, I want my free Pasta Dinner ticket
TEAM MEMBER #5
Signature of Team Member
First Name:
Last Name:
Address:
City:
Phone Number:
E-mail Address (for race information only):
Birthdate:
Estimated Finish Time:
Date
Female Technical Shirt Size:
Male Technical Shirt Size:
S q M q L q XL q XXL q
S q M q L q XL q XXL q
By my signature, I acknowledge that I have read, understand and agree to the Release, Indemnity
and Assumption Agreement.
(Hours, Minutes, Seconds)
State:Zip:
Official Use Only
Race#
Zip:
Age on Race Day:
Sex: M q F q
q Yes, I want my free Pasta Dinner ticket
TEAM MEMBER #4
Signature of Witness (required)
First Name:
Last Name:
Address:
City:
Phone Number:
E-mail Address (for race information only):
Birthdate:
Estimated Finish Time:
Date
First Name:
Last Name:
Address:
City:
Phone Number:
E-mail Address (for race information only):
TEAM CONTACT INFO (If different from team captain)
q Corporate Division (All participants must be employees of company represented)
TEAM MEMBER #1 (Team Captain)
q Open Division
First Name:
Last Name:
Address:
City:
Phone Number:
E-mail Address (for race information only):
Birthdate:
Estimated Finish Time:
Choose One:
Organization Name:
Price Each
Total
Marathon Pin miniMarathon Pin
Extras
*No Refunds
DATE
SIGNATURE OF PARTICIPANT
WAIVER REQUIRED: I know that running a road race is a potentially hazardous activity. I should not enter to run unless I am medically able
and properly trained. I assume all risks associated with running this event, including but not limited to: falls, contact with other participants,
the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and
appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry to participate in the
Derby Festival Marathon / miniMarathon (hereinafter sometimes referred to as the Event) on Saturday, April 25, 2015 (or on such date as may
be determined in the event of a postponement of the Event) in Louisville, Kentucky, I intending to be legally bound, do hereby for myself, my
heirs, my executors and administrators agree as follows: 1. I do waive and forever release any and all rights and claims for any damages
and liabilities of any kind arising out of my participation in the Event against all persons, entities and agencies involved with promoting
the Event, including the Kentucky Derby Festival, Inc.; The Metropolitan Park and Recreation Board; Walmart; Asics; Norton Sports Health;
Louisville Water Company; Coca-Cola Enterprises; Bluegrass Family Health; Anheuser-Busch; The Courier Journal; Churchill Downs, Inc.;
Active.com; MINI of Louisville; Louisville Metro Government, its officials, executives, employees and agents; Fire Chief, Louisville Division of
Fire and their officials; State of Kentucky; and Waterfront Development Corp. their agents, successors, representatives and assigns even
though that liability may arise out of negligence or carelessness on the part of the persons named in the waiver. 2. Further, I assume the
risk of all bodily injuries including death, resulting therefrom and personal injuries to me and damage to and loss of my property, including
loss of use thereof and any other indirect or consequential damages, resulting directly or indirectly, wholly or in part, from my participation
in the Event and while traveling to and from the Event. 3. Further, I hereby agree to indemnify, defend and hold the entities specifically
named in paragraph numbered 1 above harmless from and against any and all claims, liabilities, losses, damages, costs, expenses, (including
attorney’s fees), judgments and penalties arising out of any of my acts or omission to act. 4. Further, in the event that the participant is a
person under 18 years of age, the undersigned parent or legal guardian of the participant agrees to indemnify, defend and hold harmless the
entities specifically named in paragraph numbered 1 above from and against any and all claims, liabilities, losses, damages, costs, expenses
(including attorneys fees), judgments and penalties arising out of the participant’s participation in the Event. 5. Further, I understand that
Kentucky Derby Festival, Inc. reserves the right to use any and all participant’s names and/or likenesses with regard to promotional and/
or advertising materials, including on the internet. 6. Further, I understand that all entries are nonrefundable and nontransferable. 7. Race
officials have the right to disqualify or remove from the course any participant whose activity violates any condition set forth or who poses any
potential harm to himself/herself or any other participant. 8. I am not signing this waiver on behalf of a participant who is under the age of 12.
WAIVER MUST BE SIGNED TO BE PROCESSED
Make check payable to: Kentucky Derby Festival, Inc.
* Total
Subtotal
sales tax included
$6.00
$6.00
miniMarathon Team Entry (Includes a $5.00 paper processing fee)$380.00
Marathon Team of Three (3) (Includes a $5.00 paper processing fee)$305.00
Marathon Team of Four (4) (Includes a $5.00 paper processing fee)$405.00
Marathon Team of Five (5) (Includes a $5.00 paper processing fee)w$480.00
Description
Qty.
POne
Remember to check the boxes for your free Pasta Dinner tickets.
Includes a $5.00 paper processing fee
All team information must be complete to register.
2015 Kentucky Derby Festival® Marathon/miniMarathon® Team Challenge Official Entry Form