2018 RUBICK RUN

2018 RUBICK RUN
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2018  RUBICK  RUN  REGISTRATION  FORM

SATURDAY,  OCTOBER 6,  2018   Start time 8:00am

 

NAME__________________________________________            MALE________ FEMALE________

 

ADDRESS_______________________________________            PHONE________________________

 

CITY____________________________________________          STATE_________            ZIP__________

 

BIRTHDATE_____________________________                          AGE ON RACE DAY____________

 

EMERGENCY CONTACT____________________________     email  _________________________

 

By indicating your acceptance, you understand, agree, warrant and covenant as follows:

 

Waiver:

YOU UNDERSTAND THAT PARTICIPATION IN THE EVENT IS POTENTIALLY HAZARDOUS, AND THAT A REGISTERED PARTY SHOULD NOT PARTICIPATE UNLESS THEY ARE MEDICALLY ABLE AND PROPERLY TRAINED.  YOU UNDERSTAND THAT EVENTS MAY BE HELD OVER PUBLIC ROADS AND FACILITIES OPEN TO THE PUBLIC DURING THE EVENT AND UPON WHICH HAZARDS ARE TO BE EXPECTED.  PARTICIPATION CARRIES WITH IT CERTAIN INHERENT RISKS THAT CANNOT BE ELIMINATED COMPLETELY RANGING FROM MINOR INJURIES TO CATASTROPHIC INJURIES INCLUDING DEATH.  YOU UNDERSTAND AND AGREE THAT IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE IN THE EVENT, YOU AND ANY REGISTERED PARTY, THE HEIRS, PERSONAL REPRESENTATIVES OR ASSIGNS OF YOU OR THE REGISTERED PARTY DO HEREBY RELEASE, WAIVE, DISCHARGE, AND CONVENANT NOT TO SUE THE RUBICK RUN FOR ANY AND ALL LIABILITY FROM ANY AND ALL CLAIMS ARISING FROM PARTICIPATION IN THE EVENT BY YOU OR ANY REGISTERED PARTY.

 

Indemnification:

You agree to indemnify and hold The Rubick Run harmless from and against any and all damages, costs, claims or demands, including reasonable attorney’s fees, made by any third party due to or arising from or relating to your use of The Rubick Run or the violation of any term of this Agreement and Waiver as well as the Terms of Service.

 

Severability:

You further expressly agree that this Agreement and Waiver is intended to be as broad and inclusive as is permitted by the law of the State of Wisconsin and that if any provision of this Agreement and Waiver shall be found to be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and Waiver  and shall not affect the validity and enforceability of any remaining provisions.

 

BY INDICATING YOUR ACCEPTANCE OF THIS AGREEMENT AND WAIVER, YOU ARE AFFIRMING THAT YOU HAVE READ AND UNDERSTAND THIS AGREEMENT AND WAIVER AND FULLY UNDERSTAND ITS TERMS.  YOU UNDERSTAND THAT YOU ARE GIVING UP SUBSTANTIAL RIGHTS, INCLUDING THE RIGHT TO SUE.  YOU ACKNOWLEDGE THAT YOU ARE SIGNING THE AGREEMENT AND WAIVER FREELY AND VOLUNTARILY, AND INTEND BY YOUR ACCEPTANCE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

 

SIGNATURE_________________________________________________            DATE______________

 

 

Registration Fees:                                                                 Mail payment and completed form to:

$25.00            

*Make checks payable to Rubick Run                               Dave Nickels

                                                                                                604 Pine Street

Shirt size        S_____ M_____ L_____ XL_____               Manitowoc, WI 54220

 

Please contact Dave Nickels at 920-242-0899 or e-mail to dnick440@gmail.com if you have any questions.