Last Name_____________________________ First Name ______________ MI ____

Sex ______  Age on Race Day ________

Street ________________________ City _________________ State ___ Zip ______

Home Phone ___________________  Work Phone __________________

Projected Time _________________________

                     Races                                    Walks
Check One     _____ 5 mile Race                   _____ 5 Mile Walk
                 
              _____ 5 K Race                      _____ 5 K Walk

              _____ 5 Mile Wheelchair

              _____ Kid's  K

1 Person Per Entry Form - Photo Copies Accepted                       
Cool Running Entry Form

"I know that running is a potentially hazadous activity. I should not enter and run the race unless I am medically able and properly trained. I agree to abide by any decisions of a race official relative to my ability to complete the run. I assume all risks associated with running including, but not limited to, falls, contact with other participants, the effects of the road and traffic on the course, all such risks being known and appreciated. Having read this waiver and knowing these facts, I, for myself and anyone entitled to act on my behalf, waive and release Marshalls Inc., its parent corporation, affiliates, and subsidiaries, the Merrimack Valley striders, The Town of andover, DMSE, all sponsors, their directors, officers, employees, agents, representatives, and successors from all claims or liabilities of any kind or nature whatsover, arising out of my voluntary participation in this race even though that liability may arise out of the negligence or carelessness on part of the persons named on this waiver."

__________________________________________________
Signature (parent or guardian if under 18)  Date

Mail all entries to: Marshall Feaster Five Road Race, DMSE, Inc.P.O. Box 2178, Woburn, MA 01888, Fax: 617-932-8887.