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

“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 Non-refundable entry fee: 150.00, Last day of registration August 15, 2009 Submit Entry Form at AMEPA Development Foundation, Inc.

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

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  1. “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 Non-refundable entry fee: 150.00, Last day of registration August 15, 2009 Submit Entry Form at AMEPA Development Foundation, Inc. 3RD. Floor Banco De Oro Building Padre Faura cor. A. Mabini St. Ermita Manila Email: ameparun4acause@yahoo.com For online registration you can send your payment at AMEPA Development Foundation, Inc. Bank Account No. 4490372771 Banco De Oro-Padre Faura/Mabini Branch Contact Person: Mr. Buhari A. Manibpel Tel. No. 666-2592; Fax No. 526-5157 Website: www.amepadevtfoundationinc.com First Name: __________________________________ Last Name: _________________________________ MI: __________ Address: _____________________________________________________________________________Sex: _____________ Age on Race Day: _______________ Date of Birth: ________________________ Nationality: ________________________ Team/Club: ________________________ Tel. No. Mobile: __________________ Landline: __________________________ Please circle one: 3k 6k WAIVER OF LIABILITY I know that running/ walking is a potentially hazardous activity. I certify that I am physically fit and properly trained for the event I am entering and I 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 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 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 my participation in the event I entered, even though that liability may arise out of negligence or carelessness on the part of the persons and entities named in this waiver. I grant permission to all of the foregoing to use my 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. ________________________________________ Signature over printed name _______________________________ Date:___________________ (Parents signature if under 18 years)

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