First Name

Last Name

Address                                City       State  Zip
    

Email (required)

Age (on July 12th)   Male/Female      T-shirt Size (s/m/L/XL)
                      

Date of Birth
 (Ex. 01/15/1966)

 I have read and understand the release of liability
In consideration of the acceptance of my entry, I for myself, my heirs, executors and administrators, do hereby release and discharge Keeneland, and all sponsors and associates of this event from any and all claims in said event. I certify that I have full knowledge of the risks involved in participating in this event, and I am physically fit and sufficiently trained to participate in this event. I also release publishing rights of photographs taken of me during the Walk for the purpose of publicity for this and future events.

 please wait for confirmation