CIRCLE T-SHIRT SIZE: S M L X L XX L register race day 5.00 extra

Entry fees (nonrefundable): $15 Adults - $10 Students

(9th grade-college) $5 Students (1st grade–8th grade).

In consideration of this entry, I hereby for myself, my heirs, my executor and administrators; waive, release

and discourage all claims I may have against the Polk Arts Alliance, Highland City, the City of Bartow, Polk

County and its representatives, PCC and all other sponsors, volunteers, participating agencies and officials

for any and all damages and injuries of any manner resulting from my participation in PAA’s Race for the Arts

2009. I further state I am physically fit and sufficiently trained to participate in this race. I also grant permission

to any of the sponsors or officials to use my likeness in connection with this race.

Signature ___________________________Date_________(Parent/Legal Guardian must sign if under age 18.

The Polk Arts Alliance is a nonprofit 501C 3 tax exempt corporation in the State of Florida. This is a fundraiser

for PAA and for the arts and cultural organizations of the Cultural Arts Board of Polk County

Make checks payable to: Polk Arts Alliance, Inc.

Mail to: PAA, PO Box 727, Bartow, FL 33830 Telephone (863) 804-0494