2010 Little Souls Online Entry

Please fill in the requested information below, press the preview button, verify information
on the next screen then press the "Pay Here" button where you will be taken to the Paypal
processing site where you MUST select payment method and any information they require.
Once successfully paid you will be redirected to the Little Soul/ Family 5K page.
NOTE: If Payment is Successful you will receive payment confirmation email
(within 24hrs) both from Paypal and entry confirmation from us (if you do not
receive our email within 24hrs please contact us at ranmorz@telusplanet.net.)
IF you DO NOT RECEIVE CONFIRMATION YOU ARE NOT ENTERED!!.

Visa, M/C, Paypal ** ALL Payments are handled securely by Paypal ** DATA GRAPHX
and will appear on your Credit Card OR /Paypal statement as such.

SORRY ALL ENTRY FEES ARE NON-REFUNDABLE

Fees:	$27.00 With Shirt for either event ( includes $2.00 processing Fee)
	ENTRY DEADLINE May 1st
	SORRY NO RACE DAY ENTRIES

Reference:

Entry Date:

Last Name:

First Name:

Address:

City:

Prov:

Country:

Postal:

Home Ph:

xxx-xxx-xxxx

Bus/Cell Ph:

xxx-xxx-xxxx

Email:

(E-mail)

Birthdate:

mm/dd/yyyy format

Age:

Gender:

Female

Male

Race & Shirt Selection:

Category:

Shirtsize:

Fee:

Competitor Details:

School:

Grade:

Medical:

Contact:

Contact Ph:

xxx-xxx-xxxx

PLEASE READ and AGREE to the Following WAIVER of Liability Statement

In consideration of your acceptance of this race entry, I, for myself, my heirs, executors,
administrators and assigns, forever waive, release and discharge any and all rights, demands,
claims for damages and causes of suit or action known or unknown, that I may have against the
little Souls Kids Marathon/Family 5K Fun Run and any and all participating race sponsors and
supporters and directors, officers, employees and agents of such parties, for any and all injuries in
any manner arising or resulting from my participation in said race. I attest and verify that I have full
knowledge of the risks involved in this race, that I assume those risks, that I will assume and pay
my own medical and emergency expenses in the event of an accident, illness or other capacity,
regardless of whether I have authorized such expenses and that I am physically fit and sufficiently
trained to participate in this race.

Waiver Agreement:

YES I have Read and AGREE to the above WAIVER