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Group Run Name
Name (first, last) ____________________________________________
Address (Street, City, etc.) ____________________________________
Telephone ___________________Email _________________________
[ ] Yes, I am a member of Club Fat Ass
In consideration for being permitted to participate in CFA Group Runs, I hereby for myself and for my personal representatives and successors release and forever discharge CFA Group Run Hosts and Club Fat Ass, together with the officers, directors, employees, representatives, agents, sponsors and volunteers of each, of and from all actions, causes of action, claims, demands or compensation of any kind, whether presently known or unknown, and whether as a result of negligence or any other cause, arising out of or in connection with my participation in CFA Group Runs.
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--- Event Guest (signature) -------------------------- Date ---------------------