Name: Address: City: State: Zip: Daytime Phone: Age on April 2, 2006: Club: EMail: Check off the weeks you want to run below: April Events : 4/3 4/10 4/17 4/24 May Events : 5/1 5/8 5/15 5/22 5/29 June Events : 6/5 6/12 6/19 6/26 July Events : 7/3 7/10 7/17 7/24 7/31 August Events : 8/7 8/15 8/22 8/29 September Events : 9/4 9/11 [ ] Youth 14 & Under $2.00 X no. of weeks: $ ______ 10 or more $1.50 each: _____ [ ] Youth 15-18 $3.00 X no. of weeks: $ ______ 10 or more $2.50 each: _____ [ ] All other runners $5.00 X no. of weeks: $ ______ 10 or more $4.00 each: _____
Waiver Must Be Read and Signed Before Mailing: I know that running is a potentially hazardous activity. I should not enter or run this event unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running in this race including, but not limited to, falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application, I, for myself and anyone entitled to act on my behalf, waive and release the Moose Milers & Marathoners, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. All fees are nonrefundable.
_______________________________ _____________ _____________________________________ Signature Date Parent's Signature if under 18