LSoM RUN au 2/ | Last Sunday of the month RUN Mache wo REGISTRATION FORM Registration for Mar. / Apr./ May / June / July / Aug./ Sept./ Oct .2016 Registration for 5K 10K 15K Registration No: Full Name Age Gender MQ FO | BloodGroup Cell No Emergency Cell No: E-mail Address Signature hereby declare that above information provided by me is true & correct. And| also agree to the given below terms & conditions. Terms & Conditions : 1) Allparticipants must ensure they are fit enough to take part in the run. Itis also recommended that any participant (especially those above the age of 45 years old) taking part in such an event should consult their Medical Practitioner & get clearance before participatation, 2) Organisers do not accept any responsibility for accidents, injuries or lack of medical help on route. Participants will un during the ‘event at their own risk and after obtaining clearance from their respective physician/medical expert ACKNOWLEDGMENT SLIP Registration for Month : Name Registration for 5K 10K 15K Registration No: Amount Paid: %50 %300 Receivers Name & Signature