Event (circle)     Elite Start         8K    5K Run    5K Walk Name  ____________________________________ Birth Date  _____/______/________    Age on Race Day  _______    Gender  (circle)     Male      Female Address ____________________________  City  ___________________  State ________  Zip __________       Phone  _________________________________   e-mail  _________________________________________ Are you on a team?  If so, team name _________________________________________________________ Team sponsor, if applicable _________________________________________________________________ Shirt Size (circle)           Adult  S     M     L     XL    for XXL (add $2)  Shirts are not guaranteed for sign-up after Oct. 31, 2011 Extra Breakfast(s) $5 each ___________   Join KC Track Club $15 _______________ Donation to Cliff Hanger Charity -  Neighbor To Neighbor  $______________ Before October 23,  $25     After October 23,  $27      On Race Day $30 Total Amount Enclosed ________________________ WAIVER: I know that running and volunteering in running events are potentially hazardous activities. I assume all risk associated with these activities. I hereby waive and release, for myself and anyone entitled to act on my behalf, the Kansas City Track Club, the Road Runners of America, Gladstone School, Kansas City Parks and Recreation, Race Day Timing Solutions and all sponsors, charities and race officials from all claims of any kind arising out of my participation in this event.  I understand that running with a pet,  headphones, roller blades,bicycles, skateboards are not allowed and that strollers must walk and stay at the rear of the pack.  Signature ____________________________________  Date____________         (Signature of parent of guardian if under 18) Please use a separate form for each entrant. Make checks payable to: Kansas City Track Club Mail to:  Kansas City Track Club, 6718 Vahalla Drive, Shawnee KS 66217 Mail in Registration