Denbury Beaver Pond Festival

Run/Walk/Skate/Bike/Celebrate/Eat

Saturday, October 28, 2006

8:00 AM Ride, 11:00 AM Ceremony,

(Bike drawing and food to follow)

Drawing for 1 adult bike donated by Moores Bike Shop,
and 1 child’s bike donated by Hattiesburg Bicycle Center

TO PRE-REGISTER, PLEASE COMPLETE THE FORM BELOW:

Name___________________________________________________Age_____Sex___

Address______________________________________________Ph. No.____________

City/State/Zip__________________________________________________________

E-mail _________________________________________________________________

Waiver: In consideration of this entry acceptance, I hereby for myself, my heirs, executors and administrators, waive any and all rights and claims for damages I may have against the Longleaf Trace, the Beaver Pond Festival, and any individuals connected with the sponsoring of this event, and for any injuries, loss or death sustained by me.  I am in a physical condition that allows me to safely participate in this event. I hereby grant full permission to use my name and image in any photographs, videotapes, motion pictures, recordings, broadcasts, or other record of this event. I further attest that I have read this waiver and intend to have a good time at this event.

Signature___________________________________________Date_______________