Enterprise Rent A Car - DOC

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					                             Enterprise Rent A Car
              4350 Fowler St #24, Fort Myers, Fl 33901 (239) 936-5542

       Family Run/Walk Benefit in Memory of Sarah-Dian
                         Heineman
                                REGISTRATION FORM

Saturday May 16, 2009 Registration begins at 7 am – Run/Walk starts at 8:45 am
             Family Fun Activities in the Park from 10 am – 2 pm

Registration Fee’s: Adults $20 - Children (under 12) $10
Day of Event: Adult’s $25 – Children (under 12) $15

Information: Due to the nature of the course, for the safety of participant’s, unregistered
participants, unauthorized vehicles, bicycles, skateboards, roller skates / blade, baby
joggers/strollers headphones and pets are discouraged. If you disregard these restrictions you are
increasing your risk of injury to yourself and others, and assume all responsibility for injuries
occurred. Hot and Humid conditions may exist. Drink plenty of fluids prior to the race and
replenish your fluids at the aid station.


Registration Form: Please fill out form completely and clearly. Registration fee
Non-Refundable


FIRST NAME ____________________LAST NAME_____________________

ADDRESS _____________________________________________________

CITY __________________________STATE _____________ZIP __________

PHONE ___________________ EMAIL______________________________

MALE_____ FEMALE _______ AGE_____

Adult T-Shirt Size (circle one) S M L XL XXL

PAY BY CASH or CHECK: Make checks payable to Enterprise Rent-A-Car and mail by
April 27, 2009 to above address. (Attention: Melissa Hauck / Human Resources)

In consideration of our acceptance of this entry, I for myself, my heirs, devises, executers,
administrators and assign hereby waive, release and discharge any and all claims against
Enterprise Rent A Car, or anyone sponsoring or conducting this event, or their employees,
representatives or successor, for any and all damages or injuries I may suffer, I herby grant
permission for the free use of my name and picture in any broadcast or account of this event.


______________________               ______________________                 _______________
Athletes Signature                   Parent or Guardian Signature           Date