Central Arkansas Chapter Association of PeriOperative Registered Nurses (AORN) 5K

Murray Park, Little Rock, Arkansas

November 14, 2009 8:00 A.M.

Last Name:____________________________ First Name:________________________

Address:________________________________________________________________

City, State, Zip:__________________________________________________________

Date of Birth:_________________ Sex:   Male    Female     Age on 11-14-09:_________

Race: (circle one)        5K Race                      5K Walker

Shirt Size: (circle one)   Adult:   Small   Medium   Large   X-Large   XX Large                     

   Youth:   Small   Medium   Large

Fees:    $20.00 Pre-register      $25.00 Day of Race

Registration and packet pick-up begin at 6:30 A.M. on day of race.   

Race starts at 8:00. Awards at conclusion of race: Awards given for top three over all; age group awards 14 & under, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75 and older, three deep in each age group. Awards given for top three walkers overall. 

Make checks payable to Central Arkansas AORN    

Mail to: AORN 5K Run

  24 Sallisaw Court

  North Little Rock, AR. 72116

For more information call 501-228-0725 or e-mail at kawarkman@aol.com

Release: I know that running and volunteering to work in races are potentially hazardous activities. I should not enter and run in this race 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 risks associated with running and volunteering to work in races including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this

waiver and release AORN chapter of central Arkansas, Little Rock Parks and Recreation, ArkansasRunner.com, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.

Signature:_________________________________________    Date:________________

Parent Signature if under 18:_______________________________ Date:_____________