ACE Physical Therapy & Sports Medicine Institute W&OD 10K
racePacket - Mail-in Entry Form
Saturday, August 5, 2017

Make checks payable to SHF, 611 South Ivy Street, Arlington VA 22204
          First Name: 
           Last Name: 
               State:           Zip: 
       Date of Birth:       Age on Saturday, August 5, 2017: 
              Gender: Male Female
           Entry Fee: $25 for members of Friends of the W&OD 
                      $35 for non-members $25 for ACE Physical Therapy friends 
Fee On or After 2016-07-31:
                      $30 for members of Friends of the W&OD 
                      $40 for non-members $30 for ACE Physical Therapy friends.

          Shirt Size: S M L XL 
               Event: 5K Run 

Waiver Must Be Read and Signed Before Mailing:

I know that running a race such as this is a potentially hazardous activity and I assume all risks associated with such an event. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of the race officials relative to my ability to compete safely in this event. I assume all risks associated with running this event, including, but not limited to: falls, contact with other participants and non-participants, effects of weather (including high heat and/or humidity); traffic, the conditions of the road, all such risks being known and appreciated by me and voluntarily undertaken. 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 the the Road Runners Club of America, DC Road Runners Club, and all sponsors, their representatives and and successors of this event from all claims or liabilities of any kind arising out of my participation in this event, even though liability may arise out of negligence or carelessness on the part of the person named in the waiver.

_______________________________ _____________ _____________________________________ Signature Date Parent's Signature if under 18

From, Thanks for your support.

All blanks must be filled in.