3rd Annual MCAAP HIKE 2 HELP 5k

(Military Child Access Assistance Program)

May 30, 2015

CHECK IN: 8:30 am at Cannon Park Picnic Shelter in Pinehurst
Late registration: 8:30 am (but no promise of t-shirt)
Hike starts: 9:30

REGISTRATION FORM (Please Print)

DEADLINE: May 15, 2015
Please fill out completely (TO BE COMPLETED BY INDIVIDUAL RUNNERS)

Name_______________________________________________________
Team Name:_________________________________________________
AGE(day of race)_____
Address________________________________________________City_________________
State_______________________Zip__________ Telephone______________ Sex____M____F
Date of Birth________________ T-Shirt Size: S M L XL YL YM YS
WAIVER AND RELEASE: I know that walking a road race is a potentially hazardous activity. I should not enter and walk
unless I am medically able and properly trained. I agree to abide by any decision of a walk official relative to my ability to
safely complete the run. I assume all risks associated with walking in this event including, but not limited to, falls, contact
with the other participants, the effects of weather including heat or humidity, traffic and condition of the trail, 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, I, for myself and anyone to act on my behalf, waive and release MMIA (a non profit
organization), The Village of Pinehurst, the Village of Pinehurst Parks and Recreation, and all the sponsors, their
representatives and successors from all claims of liabilities of any kind arising out of my participation in this event. I grant
permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for
any legitimate purpose. In consideration of your accepting this entry, I, undersigned, intending to be legally bound hereby,
for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may
have, or that might accrue against MMIA, their agencies and employees, for any and all injuries suffered by me in said
event.

Make checks payable to: MMIA

Mail to: HIKE2HELP c/o MMIA, 625 Page St., Southern Pines, NC, 28387
Fees: 5k (3+ mile) Hike:
Team (10 Hikers) $150 minimum
**Prizes given to team that raises most money and most spirited
Please turn in all Team Hikers Registration Forms together with entry fee.
Individual Hikers All ages- $20
Late Registration (after May 15, 2015): $ 20

Sponsorship Available

Signature_______________________________________Date_________
Parents Signature (if walker is under 18 years of
age)___________________________

E-mail Address (Please Print)________________________________________________

For more information, contact Race Director at (910)528-0480, mcaap2013@gmail.com or
www.mcaap.weebly.com