SEB/LASAA 14th Annual Mud Run Entry Form Sunday, September 13, 2009 8:30 a.m. Kids Run 9:00 a.m. Open Public Run Information: LASD SWAT TEAM MUD RUN. 5plus mile course with several muddy obstacles. Entry comes with high quality T-Shirt. After race music with food and beverage available. Uniform for event is Boots & Cargo pants/jeans. Must be in proper attire to win an award. Winners will win Los Angeles Sheriff's Athletic Association (LASAA) medals and plaque. Proceeds benefit the LASD Special Enforcement Bureau Athletic Fund. Location: Pitchess Detention Center, 29300 The Old Road, Castaic, CA 91384 * Required Field Team Name * : Team Members/Individual: Name 1: LASAA Member: No Yes Name 2: LASAA Member: No Yes Name 3: LASAA Member: No Yes Name 4: LASAA Member: No Yes Name 5: LASAA Member: No Yes Captain/Individual Name: Address *: City *: Zip *: Phone *: Email *: Categories: Open Male Individual Open Team Law Enforcement/Fire Department Team Mixed Team (Min. 2 Females) Female Individual Female Team Over 40 Male Individual Over 40 Female Individual Over 40 Open Team Over 40 Mixed Team (Min. 2 Females) Explorers Fees: (All Entries Include Quality T-Shirt) Team (5 People Per Team): $100 Prior to September 11, $125 After September 11 Individual: $20 Prior to September 11, $25 After September 11 Kids: Free Day of Race Registration Accepted (Quantity *: @$20) For questions regarding this event, please contact Tom Harris or Jeff Riggin at (323) 881-7800. Please click submit to pay via next page. Registration is not complete until paid.   LASAA, Los Angeles County Sheriff's Department Waiver Release and Indemnity Agreement In consideration for allowing me to participate in the Mud Run hereafter referred to as "Event", I hereby waive, release, and hold harmless the County of Los Angeles, Sheriff's Department and it's officers, employees, agents and representatives for personal injury and property damage which may herein after accrue to me for participation in the aforementioned event. The County of Los Angeles, Sheriff's Department, LASAA, all directors, officers, agents servants, employees or officials shall not be responsible or liable for any injury, damage, loss, or expenses to me, or to my property, incurred while participation in the aforementioned event whether the injury, damage loss or expense occurs by reason of negligence, dangerous condition of public property or otherwise for myself, my heirs executors, administrators, and assign, I agree to defend, indemnify and hold harmless the County of Los Angeles, Sheriff's Dept. and LASAA Incorporated, against any and all manner of actions, claims, cause of actions, suits, debts, demands or damages or liability or expenses of any kind and nature incurred or arising by reason of any actual or claimed act or omission by me, or on my behalf, on behalf of my estate, by my administrator or executor, and by any other person including a minor claiming any injury or damage as a result of injury or loss sustained by my participation in the aforementioned event. By clicking on "Submit", I agree to this waiver release and indemnity agreement.