Return this form with your check payable to: The Town of Butler Attn: Butler Fest 2018 PO Box 455 Butler, AL 36904 For more information, call Butler Town Hall at 205-459-3795 Register Online @ msracetiming.com    Race Day Schedule – Saturday, October 13, 2018   Registration: 360 Fitness 128 West Church Street. Run/Walk: 7:00 to 7:30 am Fun Run: 8:00 to 8:30 am Starting Times: 5K Run & 2-Mile Walk 8:00 am; 8:05 am Kids’ Fun Run 9:00 am Registration Fees: 5K Run and 2 Mile Walk: $20.00 Pre-registration $25.00 Race Day Kids’ Fun Run: $15.00 Pre-registration $20.00 Race Day (T-shirts guaranteed to runners pre-registered by Oct. 3rd. Day of race registrants will receive t-shirts as long as supplies last. )  Course Course will be marked with signs. Drop off forms @ 360 Fitness in Locked Mail Box in front of Business. 2018 Butler Fest 5K “It’s Time to Get Jiggy With the Piggy”

2018 Entry Form Name_________________________________________   Name_________________________________________ Address_______________________________________ City_______________ State__________ Zip_________ Day Phone__________________ Sex (Circle one): Male or Female Birth Date : _______________ Age on Race Day _____  Email: _____________________________________ Event: _____5K Run _____2 Mile Walk _____Fun Run     T-Shirt Size: Adult S M L XL      XXL     XXXL Youth XS S M L XL Entry Fees: Race/Walk: $20 pre-registration ; race day $25                  Fun Run: $15 pre-registration; race day $20                 Total Enclosed: $__________ In consideration for the acceptance of my registration as a participant in the above entitled event, and with the understanding that my participation in this event is only on condition that I enter into this agreement, for myself, my heirs and assigns, I hereby assume the inherent and extraordinary risks inherent in any other activities connected with this event in which I may voluntarily participate. I expressly assume the risk of and accept full responsibility for any and all injuries (including death)and accidents which may occur as a result of my participation in this event and release the Town of Butler and each of their agents, representatives and employees. I hereby waive any claim I may hereafter have as a result of my participation in this event, and any other activities connected with this event in which I may voluntarily participate. I hereby agree to indemnify all of the above named persons for any and all claims including attorney’s fees and costs, which may be brought against any of them by anyone claiming to have been injured as a result of any injury to me of my property which may occur as a result of the event. I certify that I have read and fully understand this release. I am of lawful age and legally competent to make this agreement.   ___________________________________________________ Signature                                                                               Date Parent/Guardian (if under 18 years of age)                     Date