9:00am Saturday October 4

th
, 2014
Stoney Creek Park, Goldsboro NC
Check-in 8:00am 8:45am

First Name: Last Name:
Address: City:
State: ________ Zip Code: _________ Email:
Phone: ( ) - Age: __ _____

ENTRY FEES: $30.00 in advance. $35.00 Day of Race. Participants
receive a T-shirt, sun glasses, and one bag of color.


Entry locations: Wireless Xpress, 200 N. Berkeley Blvd. Goldsboro
Goldsboro Family Y, 1105 Parkway Drive
Curtis Media Radio Stations, 2581 US Highway 70 West, Goldsboro
MAIL to Curtis Media, 2581 US Highway 70 West, Goldsboro
NC 27530

Make checks payable to Curtis Media. Mail entries must be received by October 2
rd
.

Shirt Size: Please Circle the size S M L XL XXL
The WAR 5K Color Walk/Run is to benefit Wayne Uplift Resource Association, a United Way Agency that helps
individuals and families in Wayne County NC struggling with domestic violence. It is an untimed event, it is not a
competition, and no awards are given. The event ends with the Color Dance Jam. *Subject to change.

I acknowledge the WAR 5K Color Walk/Run and Color Dance Jam (5K) is an outdoor event at Stoney Creek Park, Goldsboro NC, on a course that
includes a trail with vegetation, trees, stumps, roots, limbs, debris, stones, rocks, and other imperfections found on a trail course, that it will be with other
participants where there is always the possibility of a collision or fall that results in an injury, and that both participants and event volunteers will be
throwing colored powder at me. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN THE 5K, and I WARRANT I am physically fit to participate in
this event. Additionally, I hereby take the following actions on behalf of myself and on behalf of all others, release, acquit and discharge Curtis Media
Group, New Age Communications LTD, New Age Communications Inc., WEQR, WGBR, WFMC, WELS-AM, WELS-FM, Eastern Airwaves, LLP, Wireless
Xpress, Wayne Uplift, any other sponsoring groups, officials, property owners including the City of Goldsboro, (all collectively known as Sponsors),
and all people or groups participating in and its successors, assigns, masters, principals, heirs, agents, administrators, receivers, independent contractors,
insurers, reinsurers, partners, servants, employees, subsidiaries, or affiliated corporations or divisions, predecessors or successors in interest, as well
as all other persons, firms or corporations with whom the persons or entities released hereby have been, are now, or may hereafter be affiliated of and
from any all liability, claims, demands, controversies, damages, actions, causes of action, of every kind and character whatsoever, including expenses
heretofore or hereafter incurred, which either I or anyone acting on my behalf may now or hereafter have, directly or indirectly in any manner arising from
my participation in this 5K. I understand that events, such as this one, have inherent dangers, and I assume all risks, both known and unknown, that in
any way arise from my participation in the event. I understand that by signing this Release of Liability, I agree not to sue the Sponsors, its insurers,
subsidiaries, and principals for damages in any way connected with my participation in this 5K. Likewise, I agree to not present any claims for damages
arising my participation in this event to the Sponsors, its insurers, claims handlers, subsidiaries, and principals. I also authorize the Sponsors and their
designee(s) to photograph and/or videotape me involved in any activities associated with the 5K. I also authorize the Sponsors and their designee(s) to
publish and/or otherwise use any pictures, videos, image or other likeness of myself in any promotional materials for an indefinite period of time. I realize
that I may not sue the Sponsors for any damages that I claim I sustain, or that are allegedly sustained on my behalf, in connection with the use of
photographs of me, videos of me, images of me, or likeness(es) of me. This document is a binding, legal document. I have read it and understand it. I
HEREBY AFFIRM I AM EIGHTEEN (18) YEAR OF AGE OR OLDER. I HAVE READ THIS DOCUMENT AND UNDESTAND THE CONTENTS.

SIGNATURE: ________________________________________________ DATE: _____________________

IF UNDER 18 Years of Age: Parent or Guardian signs here X__________________________________,
and assumes all responsibilities and obligations as described herein.