Cuke Patch 5k Glow Run Entry Form

Check-in opens at 7:30 pm. Run starts at 8:00 pm. Near the intersection of John and Center Streets in the vicinity of Ribeyes Steakhouse, 112 N. Center Street, Mount Olive, NC. Follow the signs to enter the downtown area via John Street. FEES $20 - Pre-registered individual, before March 15 $25 - Individual registration after March 15 $15 - Pre-registered group rate, before March 15 (4 or more) $20 - Group registration after March 15 (4 or more)

RELEASE OF ORGANIZERS AND SPONSORS of the Cuke Patch 5K Glow Run (the Event.) In consideration of the acceptance of this entry, I hereby, for myself, my heirs, executors, administrators, assigns and/or legal representatives, do hereby waive, release and discharge the Mount Olive Area Chamber of Commerce, the Town of Mount Olive, NC, the sponsors and all Event personnel from any and all claims for damage suffered by me as a result of my participation in or travel to or return from the Event. In addition I certify that I am in proper physical condition to participate in the Event and accept full responsibility for my own safety during the Event.