Official Registration Form

Send this form with payment to Curt Klein, 6025 4th St. SE, Carrington, ND 58421

or email Curt with necessary form information at cklein@daktel.com

Waiver:  I hereby enter the Bald Eagle "Walk-the-Talk" 5/10K Run/Walk at my own risk and personally assume any risk or responsibility for injuries incurred as a direct or indirect result of my participation in this event.  I further agree to not hold the Carrington Area Toastmasters, race directors, sponsors, or any party associated with this race responsible for any injury.

Please print the following information neatly!

Name: ________________________________________________________

Address: _____________________________________________________

City/State/Zip: _________________________________________________

Phone Number: ________________________________________________

Email Address: ________________________________________________

Sex:  M  F    Date of Birth: _________________ Age on Day of Race: _____

T-Shirt Size:  S    M    L    XL    XXL

Signature: _____________________________________________________

Signature of Parent or Guardian if under 18 Years of Age:

______________________________________________________________