Name: 
        Address: 
           City: 
          State:    Zip: 
          Phone: 
  Date of Birth:    Age on race date: 
         Gender: M F
     Shirt Size: S M L XL 

      Entry Fee: Thru 7/20: $20 After July 20: $25

 
  

Waiver Must Be Read and Signed Before Mailing:

I know that running a road 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 runnimg this event, including but not limited to contact with other participants, effects of the weather including high heat and/or humidity, traffic, and the condition 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 American Legion Post #1776, RacePacket, Inc., PVA, USATF, and any other sponsors and their representatives and successors from all claims or liabilities of any kind arising out of my participating in the event even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, or any other record of this event for any legitimate purpose.

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

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