ADDRESS:_____________________________________________________________________

CITY:____________________________________ STATE:____________ ZIP:_______________

PHONE (include area code): ________ - _____________________

DATE OF BIRTH:_________________ AGE (on 10/07/06)   SEX: (circle one) :    M     F

T-SHIRT SIZE (circle one) :   S      M      L     XL

E-MAIL:______________________________________________________________

The undersigned does hereby voluntarily waive my right to any and all claims or causes of actions against the Oxford Kiwanis Club, Kiwanis International or any officer, agent or member of said Oxford Kiwanis Club or Kiwanis International, City of Oxford and race sponsors and volunteers as the same relates to the event made the subject hereof and further agrees to indemnify and hold harmless the above referenced parties against any and all claims or causes of action brought against either of them as the result of conduct of the undersigned. 

SIGNATURE:__________________________________________________________

Fee: $12 in advance, $15 day of race.  For Anniston Runners Club members only, race day fee is $12.   Make checks payable to Oxford Kiwanis Club and mail to P.O. box 3384, 
Oxford, AL  36203