Miles for Food Online Registration

5th Annual Miles for Food
Sunday, November 20, 2011
RT 66 State Park
St. Louis County, MO
Race Starts 9:00AM
Cut off 6 hours
(All team registration closes September 25, 2010)

Registration Form:


Name
Address
City, State, Zip	,
Home Phone
Work Phone
Email Address
Referred By
What team are you joining? Note: Team SLUGS, The Can Clan and LMHFM are currently filled.
Do you understand that to participate in this event you will be required to fundraise? If no please review F.A.Q. segment - click here Yes No
What distance are you committing to cover on event day? 5K 10K Half Marathon(13.1 miles) Full Marathon (26.2 miles) 10 Miles 20 Miles 50K (31.1 Miles) Is this your first time participating in our event? Yes No
What size T-shirt do you wear?

Submission of this form does not guarantee placement in Miles for Food. Registration is not complete until confirmed by a representative from Miles for Food. Registrants must be 18 years or older to utilize the online registration form. Individuals under the age of 18 who wish to participate must provide consent from a parent or legal guardian before registration will be considered.

By submitting this form, you agree to the following terms and conditions:

Terms & Conditions

I understand that the Miles for Food event is a charity food drive and that participation on event day IS dependent on successfully obtaining fundraising goals. I understand that these goals will require the generation of donations in the form of monetary and food items. I understand that the amounts may vary depending on the number of participants on my team but that the team totals remain constant. (to review team totals see the FAQ page)

Though Miles for Food may offer support resources to augment fundraising and training efforts, I understand that it is solely my responsibility to obtain fundraising and mileage goals.

WAIVER: In consideration of your accepting of this entry, I, the undersigned, intending to be legally bound, hereby, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Shifting Consciousness, L.L.C., Missouri State Parks, the Missouri State Park – Route 66, the State of Missouri, the Miles for Food Event and all affiliates, Operation Food Search, or any sponsor or contributor to this event and their representatives, successors, and assigns for any and all claims or liability of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I agree to abide by any decision of a race official relative to my ability to safely complete this run/walk. I assume all risks associated with running/walking in these events on November 20, 2011 , including but not limited to falls, contact with other participants, the effects of the weather, traffic and the conditions of the road. I attest and verify that I will participate in this event as a footrace entrant, that I am physically fit and sufficiently trained for the completion of this event. My physical condition has been verified by a licensed Medical Doctor. Further, I hereby grant full permission to any and all of the aforementioned parties to use my name, likeness and voice, as well as any photographs, videotapes, motion pictures, recordings, or any other record of this event in which I may appear for any legitimate purpose.