“AMEPA RUN FOR A CAUSE”SM Central Business Park, Bay City, Pasay City

Mall of Asia August 16, 2009, Sunday, 6 A.M.

OFFICIAL ENTRY FORM TEAM: ____________________________________ 3Km

WAIVER OF LIABILITYWe know that running/walking is a potentially hazardous activity. We certify that we are physically fit and properly trained for the event we are entering and we assume all risks associated with running/walking in this event including, but not limited to: falls contact with other participants, the effects of the weather, conditions of the course all risks being known and appreciated by our group/team. Having read this waiver and knowing these facts and in consideration of your accepting our entry, We, for ourselves and anyone entitled to act on our behalf, waive and release AMEPA Development Foundation, Inc./ Committee on Sports and Special Services and all other sponsors, their representatives and successors from all claims or liabilities of any kind arising out of our participation in the event we entered, even though that liability may arise out of negligence or carelessness on the part of the persons and entities named in this waiver. We grant permission to all of the foregoing to use our name, likeness and identity in any photographs, motion pictures, recording or any other record of this event in perpetuity, throughout the world, in any media now known or developed later on for any legitimate promotional purpose.

Submitted by: _________________________________ Date: _________________Coach/Team Head’s signature overprinted name

No Name Day of Birth SexAge on Race Day

Signature of Runner

Race Number (to be filled up

by the organizer/s)

1

2

3

4

5

6

7

8

9

10