Brewery Exchange Classic Entry Form

Brewery Exchange 5K
September 1, 1996
PRINT CLEARLY


Last Name _________________________________________

First Name _________________________________________

Age ____  Sex _____

Address ____________________________________________

City _______________________________________________

State ____  Zip _______ Phone #________________________

Check Here if attending Pasta Dinner  _________
Check Appropriate Race:  5K _____    Kiddie K  _____

Mail Application fee ($10 pre, $12 post) to: Brewery Exchange Classic,
P.O. Box 442, Lowell, MA 01853

RELEASE & WAIVER: I know that running is a potentially hazardous activity. I also know that there will be traffic on the course route, and I assume the risk of running in traffic. I also assume any and all other risks associated with running this event including, but not limited to, falls, contact with other participants, the affects of the weather including high heat and/or humidity, all such risks being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry fee, hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, convenant not to sue, and waive, release, and discharge all sponsors, race officials and volunteers, the City of Lowell and the State of MA. including their agents, employees, assigns, or anyone acting on their behalf, from any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the couse of, my participation in this event. This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown. I, the undersigned, further grant permission for the use of any photographs, videotapes, motion pictures, or any other recording of this event for any purpose. The race director reserves the right to reject any entry.


Signature______________________ Date______________
Parents Signature (if under 18)

(UNSIGNED RELEASES WILL BE REJECTED)
CLEAR SAME SIZE PHOTOCOPIES ACCEPTED