MARATHON SPORTS 5 MILER APPLICATION

Name ___________________________________________________________

Address _________________________________________________________

City ___________________________State___________ Zip ______________

Telephone ______________________Age (7/10/97)______________________

Club ________________________________Fastest 5 Mile time ____________

Waiver: In consideration of your accepting this entry, I hereby for myself, my heirs and executors, waive and release any and all rights and claims for damages I may have against the race directors, Marathon Sports/Back Bay Road Runners for any and all injuries, damages and/or claims of any description which might arise out of the Marathon Sports 5 Miler and all activities in any way connected therewith. I attest and verify that I am physically fit and have sufficiently trained for the competition of the race.
Signature (All entrants must sign) _______________Date __________________

Mail application/signed waiver and fee to:
Marathon Sports 5 Miler, 255 Washington Street, Wellesley MA 02181
Entry Fee

$12 before 7/1 ($15 after 7/1); checks payable to Marathon Sports 5 Miler Road Race.