2014 iCureMelanoma 5k

I acknowledge that I voluntarily apply to run in the iCureMelanoma 5K, and that there are risks inherent in the race which may result in serious injury and property loss or death. I assume the risk of participating. In consideration of this entry acceptance in the iCureMelanoma 5K, I hereby for myself, heirs, executors and administrators waive any and all rights and claims for damages against Full Spectrum Dermatology, the City of Fullerton, and all participating sponsors and their offi cers and agents, and any individual or organization associated with iCureMelanoma 5k for any and all losses, injuries or death sustained by me in this event. I hereby certify that I am in good condition and am able to safely compete in this event. I consent to receive medical treatment should I sustain injury during the event. Additionally, I permit the use of my name and pictures in broadcasts, telecasts, newspapers, brochures, etc. as a participating athlete. I certify all information provided by me in this form to be true and complete. I have read the entry information provided for the event and certify my compliance by initialing below: SecureFee™ Registration Cancellation Insurance is offered in most states. If purchased, your registration may be covered for one of the covered reasons stated in the policy.