Saturday, October 15, 2005 -- Oakland, MD
Autumn Glory Race for Sight (iPO Event Id#: 7104)
Return to the Details Page
Registration: $17.00 late registration after October 1, 2005 and day of race.
(Add $2.00 for XXL sweatshirt)
Make checks payable to: Oakland - Mtn. Lake Park Lions Club
Mail to: Paul Shockey, 920 Broadford Road, Mtn. Lake Park, MD 21550
COMPLETE, SIGN, PLEASE TEAR OFF BOTTOM PORTION & RETURN WITH REGISTRATION FEE
REGISTRATION FORM - PLEASE PRINT:
Name: ______________________________________________________ Age on 10/15/05 _________ Sex: Male _ Female _ Address : ______________________________________________________ _____________________________________________________________ City/ State/Zip Code Phone (__________) _______________________ Sweatshirt (Circle one): S M L XL XXL ($2 extra) 5K Run: __ 2 Mile Walk __Waiver of Liability: In consideration of the acceptance of my entry in the Autumn Glory Run/Walk for Sight, I certify I am physically fit to participate and I do agree to be bound by all the rules of the race and all decisions of the official judges. I assume all risk associated with running in this race, including, but not limited to falls, contact with other runners, the effects of weather, traffic and the condition of the road; all such risks being known and appreciated by me. I do hereby forever release and discharge Oakland - Mtn. Lake Park Lions Club, all race officials, all volunteer workers, and any other race sponsors and their representatives, successors, and assigns of all foregoing from any and all claims courses of action or suits, which I or my heirs or assigns, shall or may have arising from or as a result of my participation in the said race to be held on October 15, 2005. I hereby consent to use of my name and /or photograph in connection with publicity about the race.
X _______________________________________________________
Signature of Participant
X _______________________________________________________
Signature of Parent/Guardian (If under 18)