PA D C A MILE Sponsored by J Leslie Smith & Company Inc 65 YEARS in the prime of our life Senior Citizens Join Us For Our Fun Morning Out! For more info. visit www.padca.co.za or contact Jean Jackson on adminsec@padca.co.za or 033 345 4711 Full Name: Id Number / Date Of Birth: Contact Number: Email Address: 7 km 3.5 km 1 km (tick please) Indemnity and Waiver: I accept full responsibility for my own safety, heath, wellbeing and for the protection of my possessions and goods in the course of and during this organised event. I indemnify PADCA, J Leslie Smith & Company Inc. and all other parties responsible for the organisation of this event against any claim for any loss or damages I may sustain as a result of my participation in the events surrounding and the participation in this event. I waive and abandon any claim that I may have against PADCA, J Leslie Smith & Company Inc. and any other person involved in the organisation of this event for any loss or damage I may suffer to my person or property. I specifically acknowledge that I have voluntarily undertaken the risks associated with being involved in and participating in the event. In general this waiver and indemnity applies to any damage or loss of whatsoever cause. I agree that by participating in this event that you are able to use the photographs taken in any future media or publicity. Signature PADCA Seniors Are ce rn O u r Bu s in e s s A n d O u r C on Date