Nashua Soup Kitchen & Shelter 16th Annual Run for Food & Shelter Sunday April 5, 2009 Nashua, New Hampshire Sponsored by Subaru of Nashua

Mail-in Registration Form Nashua Soup Kitchen & Shelter, 5K RunWalk/10K Run/3K Walk/Kids Sprint Make Checks Payable To: NSK&S Mail Entry To: NSK&S, Inc. PO Box 3116 Nashua, NH 03061 Separate application required for each participant. Copies accepted. Name: Address: City: State: Zip: Email address: Daytime Phone: Date of Birth: Age on race date: Gender: M F Police Officer Series Participant Club affiliation: 10k Run 5k Run 3k Walk Kids Sprint Fees: $20 by 3/21/09...........................__________ $25 after 3/21/09..........................__________ $5 Kids Sprint age 9 & under......__________ Donation.....................................__________ Total Enclosed..........__________ Waiver Must Be Read and Signed Before Mailing: I know that running a race is a potentially hazardous activity. I should not enter and run 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 event including, but not limited to, falls, contact with other participants, the effects of weather (including high heat and/or humidity), traffic, and the conditions of the road, 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, I, for myself and anyone entitled to act on my behalf, waive and release Subaru of Nashua, NPPA, the Nashua Soup Kitchen & Shelter, Inc., the Granite State Race Services, the Nashua YMCA, the City of Nashua and sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event. I give my full permission to use my likeness in all media, photo, recording or other record of this event for any legitimate purpose. I understand that bicycles, baby joggers or strollers, roller skates or blades, and headsets are not allowed in the race and I will abide by this guideline. I understand this race will use the ChampionChip Timing chip. It will be my responsibility to return the chip when the race is finished. If I do not return the chip, I understand I will pay a $35.00 Lost Chip Charge to the NSK&S. In the unlikely event the race is cancelled, all fees will be considered donations to the NSK&S. I have read the entry information provided and certify my compliance by my signature below. _______________________________ _____________ _____________________________________ Signature Date Parent's Signature if under 18

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