Marathon Charity Cooperation • Walk-To-Run Program • Registration Form & Waiver

Please read and sign this registration form and waiver.  By registering for this Training Program, you accept the terms listed in this waiver.  I, for myself, as well as for my heirs, executors, administrators, trustees, and assigns, hereby waive and release any and all rights and claims for any fatality, injuries, and/or damages, including, but not limited, to demands or actions for negligence, premises liability, emotional injury, intentional conduct, tort claims, and any other actions of demands of whatsoever nature I have or may have in connection with my participation in this Training Program, including Marathon Charity Cooperation and its contractors, employees, officers, directors, agents, volunteers, and representatives; John Steitz; Arlington County and Fairfax County and their elected officials, employees, contractors, and representatives; National Park Service and Northern Virginia Regional Park Authority, their officials, employees, contractors, and representatives; and otherwise agree to hold these entities harmless.  I acknowledge that I am aware of the inherent risks (physical and otherwise) involved in these events, and I voluntarily assume these risks.  I attest and verify that I am physically fit and I have sufficiently trained for the completion of this Training Program and that my physical condition has been verified by a licensed medical doctor.  Further, I hereby waive any rights to and grant full permission to any and all of the foregoing entities to use my name, my voice, my picture, or my likeness in any broadcast, telecast, transmission, advertisement, promotion or other account of these events for any purposes whatsoever.  I understand that my registration fee is non-refundable and non-transferable and that Marathon Charity Cooperation reserves the right to reject any entry and to change the details of this Training Program without prior notice.

_____________________________     ______________________

Signature                                                Date                                    .

 

Name   _________________________________________________________________________   M / F [__]

 

Address __________________________________________________________________________________

 

City, State, ZIP _________________________________________   Phone _____________________________

 

E-mail  ___________________________________________________________________________________

 

Birthdate __ __ - __ __ - __ __ __ __    

Enclosed is my registration fee:

[_] Complimentary first session (sign in)

[_] $20 – MCC Members (use form below to join MCC)
[_] $30 – Non-members

OPTIONAL:  MCC Membership Application – Join MCC and save $10 on each of our programs and races

MCC’s Mission:  Marathon Charity Cooperation (MCC) is a non-profit corporation organized as a charitable and educational foundation for the benefit of the public both locally and globally. The MCC mission includes funding a cooperative of non-profit member-charities who both benefit from and contribute to the events hosted. Our events provide opportunities for personal and professional growth in addition to education of the public serving people of all ages.

[_]   I apply for 2009 membership in Marathon Charity Cooperation.  Enclosed is my check to MCC for $10

Please make checks payable  to MCC, 2776 South Arlington Mill Drive #246, Arlington VA 22206