REGISTRATION FORM

NAME FIRST NAME MIDDLE NAME

DATE OF BIRTH AGE GENDER

COMPANY NAME OFFICE TEL. NUMBER MOBILE NUMBER

EMAIL ADDRESS BLOOD TYPE WEIGHT/HEIGHT

DISTANCE RUN (Please

5K 10K
check) 16K SINGLET SIZE :

In case of Emergency, Please contact:

Name: Contact Number:

Address:

WAIVER OF LIABILITY

This is to certify that the undersigned is aware that any form of sports. Like the Run To Feed 4, is potentially a hazardous activity. I agree
not to enter and engage in such activities unless I am medically able and properly trained. I agree to abide by any decision of the event
organizers or sports coordinators relative to my ability to safely complete the activities mentioned hereto. I assume all risk associated
with the activities in this event, including, but not limited to: falls, contact with other players, effect of the weather, conditions of the
course, and all risk 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 entitled to act on my behalf, waive and release, Touch Mobile , AM Runners and the
Municipality of Bustos employee and all its officers , their representative and successors, form all claims or liabilities of any kind arising
out of my participation in this event.

I also grant permission to all of the foregoing to use my name, likeness and identity in any photography, motion picture, ad or any other
record of this event in perpetuity, throughout the world in any media known or developed later for any legitimate promotional purpose.

I have read and understand everything written above.

____________________________________________
RUNNERS PRINTED NAME AND SIGNATURE/DATE