Runner Registration Info Form-JDRF

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2014 “FFR” Runner Info Registration Form
Chevron Houston Marathon
Aramco Houston Half Marathon
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Race:
Chevron Houston Marathon
Aramco Houston Half Marathon
First Name: _________________________
Gender:
Male
Middle Initial: ____
Last Name: ______________________________
Female
Mailing Address: ____________________________________________________________________________
(Street)
____________________________________________________________________________
(City)
(State)
Phone: ______ - ______ - __________
Age on Race Day: ________
(ZIP)
Email: _____________________________________________________
Date of Birth: _____________________ / _________ / _____________
(January 13, 2013)
(Month)
Participant Shirt:
(Country)
SM
MD
(Day)
LG
XL
(Year)
XXL
(Unisex cotton shirt – sizes are subject to availability)
Finisher Shirt:
Men’s
Women’s
SM
MD
LG
XL
XXL
(Under Armour tech shirt – sizes are subject to availability)
Cell Phone: ______ - ______ - __________
Name on bib: ___________________________________
(Emergency race information may be sent via text)
(Limited to 14 characters and subject to review)
Emergency Contact Name: _________________________________
Wheelchair Entry:
Race Distance:
Yes
5K
No
10K
Is this your first race:
10 Miler
Half Marathon
Best time in past 2 years: ____Hrs ____Min ____Sec
Phone: ______ - ______ - __________
Yes
No
Marathon
Expected finish time: ____Hrs ____Min ____Sec
How did you hear about this event: _________________________________________
(Sponsor employee, magazine, newspaper, internet, TV, radio, previous participant, EXPO, word of mouth, charity, other)
Are you aware of the Houston Marathon Committee’s efforts to go green:
Is participating in a certified green event important to you:
Yes
Yes
No
No
(continued)
First Name: _________________________
Middle Initial: ____
Last Name: ______________________________
WAIVER: In consideration of your acceptance of this entry, I, the entrant, have submitted this entry, intending to be legally bound
for myself, my heirs, executors, administrators and assigns, and I do hereby waive and release all rights and claims for damages that I
and my heirs, executors, administrators and assigns may have against the Houston Marathon Committee, Inc., Chevron USA Inc.,
Chevron Products Company, Aramco Services Company, El Paso Corporation, H. E. Butt Grocery Company, USA Track and Field, the
City of Houston, the City of West University Place, all official sponsors, and the respective affiliates, subsidiaries, directors, officers,
employees, agents and volunteers of all of the foregoing, and their respective heirs, executors, administrators, successors and
assigns, for any and all injuries, physical or otherwise, suffered by me in this event. I agree to abide by all rules governing the event
for which I am registering. I will not permit my registration to be used by another person and I acknowledge that a violation of this
rule will subject both myself and the user to a two-year ban from all Houston Marathon Committee events. I understand that the
event occurs on the streets of Houston only during specified times and I agree to limit my participation in the event to those
specified times. I will not run on the streets utilized by the event when such streets are not closed to vehicular traffic. I attest and
verify that I am physically fit and have or will have sufficiently trained for the completion of this event, and that my physical
condition has been recently verified by a licensed medical doctor. I understand that if I am unable to participate in this event, for any
reason, the Houston Marathon Committee will not issue any refunds. Further, I hereby grant full permission to use photographs,
videotapes, motion pictures, and records of me, or any other record of this event, for any legitimate purpose. This entry is invalid
unless affirmatively marked by entrant. If entrant is under 18 years of age, a parent or guardian must affirmatively mark this entry.
The race committee reserves the right to reject any entry.
I agree to abide by all rules governing the event for which I am registering. I will not permit my registration to be used by another
person and I acknowledge that a violation of this rule will subject both myself and the user to a two-year ban from all Houston
Marathon Committee events. I understand that the event occurs on the streets of Houston only during specified times and I agree
to limit my participation in the event to those specified times. I will not run on the streets utilized by the event when such streets
are not closed to vehicular traffic.
The registrant acknowledges that MarathonGuide.com/Web Marketing Associates has no responsibility for the operation of the
Chevron Houston Marathon and associated events and is only acting as an agent to register applicants who wish to participate in the
Chevron Houston Marathon and associated events. Accordingly, the registrant agrees to hold MarathonGuide.com/Web Marketing
Associates and its agents harmless from any liability or injury resulting from the Chevron Houston Marathon and associated events.
Furthermore, the registrant agrees that it shall have no claim against MarathonGuide.com/Web Marketing Associates for any injury
that may occur during the Chevron Houston Marathon and associated events. The individual event operators and sponsors have
provided information included in this site and MarathonGuide.com/Web Marketing Associates does not verify the accuracy or
completeness thereof. All confirmed orders are final once payment is submitted. MarathonGuide.com/Web Marketing Associates
does not issue refunds.
I understand that there is a no refund policy and if I am unable to participate, for any reason, my registration fee and all monies
raised/donated for this entry will be forfeited.
______________________________________________________
__________________________
Signature
Date
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