REGISTRATION FORM

Name: _____________________________________________________________________ 

Address: __________________________________________________________________

City: ______________________________ Prov/State: _______ Postal/ZIP:_______ 

Phone: (_____)_____________________ E-Mail:________________________________

Date of Birth MM____ DD____ YY____ Sex: Male____ Female____

ORA/OTFA No.: _____________________ 

Previous Best Marathon/Ultra Time_________________________________________

Occupation: _____________________

Release Waiver and Indemnity

To participate in the Pick Your Poison Trail Run on Saturday May 01, 2010, I accept, have read and understand all rules and regulations of the Ontario Ultra/Trail Series and of this specific event that I am entering and will comply fully with them. I am aware that a run of the distance and conditions specified for the specific event I am entering, may be extremely difficult and hazardous even for well-conditioned athletes under the most favourable conditions. I am also aware of the risks of adverse weather conditions, which may accompany the event on the day of my participation. I understand that I should not participate in this event unless: (1) I am in excellent physical condition, (2) I have trained adequately for this event, and (3) I have no medical condition that might be worsened by vigorous activity. Knowing these facts, and in consideration of your accepting this entry, I hereby for myself, my heirs, executors and administrators waive, release and discharge the Ontario Ultra/Trail Series and all its officials, the Ontario Road Runners Association, The Ontario Track and Field Association, all of the various sponsors, the Race Director and their staff, agents, officials, Online Registrations, volunteers, or any other person involved in this specific event, and all government or private jurisdictions in which the specific event may take place including all Ontario Ultra and Trail events in the 2009 series, but not limited to the Hamilton Region Conservation Authority, the City of Kingston, the Royal Military College, City of Pickering, Dell Management, Metro Toronto Conservation Authority, The Ontario Provincial Government, The Bruce Trail Association, The Halton Conservation Authority, The city of Milton, Kelso Conservation Area, The Haliburton Forest & Wildlife Reserve Ltd, The City of Ottawa, The City of London, Upper Thames River Conservation Authority, Fanshawe Conservation Area, The City of Toronto, The City of Cambridge, The Grand River Conservation Authority, The Region of Waterloo, The City of Niagara Falls, The Region of Niagara, Niagara-On-The-Lake, The City of Owen Sound, Township of Georgian Bluff, Gray Sauble Conservation Area, Sydenham Bruce trail club, Simcoe County, Dufferin County, Clearview Township, Mulmur Township, Messrs Charlie Tidd, Cliff Weston and Stuart Lombard from any and all claims of liability, for any and all injuries to me (including, but not limited to death), or my property arising out of, or in connection with, this event and covenant not to sue for damages with respect thereto. This release extends to all claims of every kind and nature whether foreseen or unforeseen, known or unknown. I declare that I have sufficiently trained to participate in this event and assume all risks associated with such participation in such an event. The race director (s) and/or executive members of the Ontario Ultra/Trail Series Board hold the right to cancel any event should weather or any other condition make it potentially unsafe for the participants and/or event volunteers, and reserve the right to remove any participant from a race for any reason including but not limited to infraction of rules or for medical reasons. Finally, I hereby grant my permission to the race organizers and Ontario Ultra and Trail Series sponsors to use my name, mailing address and any photographs, videotapes, recordings, or any record of my participation in this event for any purpose. My personal information will not be sold by either the Ontario Ultra and Trail Series or their sponsors.

Signature________________________________     Date _____________________