Fat Boy 5K & 1 Mile Run/Walk Race Application
 April 5, 2008 in Baton Rouge, Louisiana

Fill in all information
Circle One:    5K      1 Mile 

Preregistration (by March 31)        ____ $12.00 ($10 for CSR Members)

Late Registration (after March 31)   ____ $15.00 ($12 for CSR Members)
*Add $2.00 for XXL shirt			 ____ (please check for XXL)
  
**No T-Shirt - $8.00                ____ (please check for NO t-shirt)         
         
Grand Prix number                   _________________
                                    
Shirt Size  ____ Small  ____ Medium  ____ Large  ____ XLarge  ____ XXLarge
Register by March 31 to guarantee race day t-shirt!
Make checks payable to:  Club South Runners
                         P.O. Box 65123
                         Baton Rouge, LA 70896  
All entry fees are non-refundable.

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Last Name                              First Name                      Sex 

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Mailing Address                        City                State   Zip Code

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Phone Number          Email Address (if you are not on Ben's list)

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Age on Race Day	    Birth Date (mm-dd-yyyy)

I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all the risks associated with running in this event but not limited to fall, contact with other participants, the effects of weather, including high heat and/or humidity, traffic and other conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Club South Runners, Inc. and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I grant permission in this event to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purpose. All forms must be signed. Incomplete or unsigned forms will not be accepted. 

Signature ___________________________________________   Date _______________


Signature ___________________________________________   Date _______________
          Signature of parent or guardian if entrant is under 18.