Entry Form - Please Print

Please make checks payable to "Corrib Charitable Trust, Inc." ($20 Pre-entry - $20 Race Day) or register by credit card:

Name: ________________________________Sex: ______ Age: __________

Address: _______________________________City: ____________________

State: ________ Zip: ____________ Phone No.: (_____) __________________

E-mail address: __________________________________________________

Pre-Reg: $20 ___ Race Day: $20 ___ Runner: ___ Wheel Chair: ___
Contribution: $ _____

I assume all risks associated with the participation in this event including, but not limited to, falls, contact with other participants, the effects of the weather, traffic and road conditions, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, the City of Boston, MDC, the Corrib Pub and Restaurant, the Corrib Charitable Trust, Inc., race officials, volunteers, and all sponsors, their representatives and successors are hereby and forever released from any and all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, recording, or any record of this event for any legitimate purpose.

Signature of Entrant: ______________________________ Date: _________
(Signature of parent/guardian if under 18)