OnlineRegistrations

Event Date: September 9th, 2010
Event Location: Sportsworld Crossing, Kitchener, Ontario
Start Time: 6:00PM
Distances: 8km.
Event Contact Info: www.mudpuppychase.com 519-744-1616 info@mudpuppychase.com

Online registration will close at 6pm on Tuesday Sep 7th 2010

Registration Instructions

Enter the required information below.
Confirm the information you entered and get total to be charged.
Enter your credit card information.
Transaction is processed and a receipt is emailed to the address you supplied.
Check the online confirmation list. If there are any questions about your online registration please contact us at mudpuppy@onlineregistrations.ca.

All fees non-refundable and non-transferable.
Required information is marked with a red asterisk (*).

Choose your event	Event	Entry Fee (till Aug 1st)	Entry Fee (from Aug 1st)
	8km	$25	$30

Enter Your Personal Information

*First Name:
*Last Name:
*Email Address:	(we will send your receipt to this address)
*Phone (+ area code):	()-
*Gender:	female male
*Date of birth:
*Age:
*Street:
*City:
*Prov./State:
*Postal/Zip Code:
*Shirt Size:	S M L XL

Release Waiver and Indemnity

This waiver form must be agreed to or your entry will NOT be accepted.
If the Entrant is not 18 years of age, a parent/guardian must agree to this waiver form.

The below parent/guardian consents to the entrant’s participation in the event and acknowledges that he/she is bound by the waiver form to the same extent as the entrant. In consideration of the acceptance of my application and the permission to participate as an entrant or competitor in the The Mudpuppy Twilight Trail Run to be held on September 9, 2010, I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVER, AND FOREVER DISCHARGE, The City of Kitchener, The Region of Waterloo, Kitchener Grand River Rotary, Rotary InternationalOnline Registrations and all other associations, sanctioning bodies and sponsoring companies, and all their respective agents, officials, servants, contractors, representatives, successors, and assigns OF ALL AND FROM ALL claims, demands, damages, costs, expenses, actions, and causes of action, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED, arising or to arise by reason of my participation in the said event, whether as spectator, participant, or otherwise; whether prior to, during or subsequent to the event AND NOTWITHSTANDING that same may have been contributed to or occasioned the negligence of any of the aforesaid.

ATTESTATION - I attest and verify that I am fully aware of the physical risk of injury or death in participating in this event and voluntarily agree to accept full responsibility and legal liability for same, that I am fit and have trained sufficiently for this event. I am also aware that the weather conditions on Thursday September 9, 2010 may be unpredictable thus posing an increased physical risk. By submitting this entry, I acknowledge having read and agreed to the below waiver, release, indemnification and attestation.

I ATTEST AND VERIFY THAT I AM 18 YEARS OF AGE OR THAT I AM SIGNING AS THE LEGAL GUARDIAN ON BEHALF OF AN EVENT PARTICIPANT UNDER THE AGE OF 18 YEARS.

Agreeing to this waiver and registering online for this race by me, for myself or as legal guardian of an event participant, in an electronic format authorizes you to accept this waiver as signed by me.

I have read and agree to the waiver.

Parents name if under 18 years of age