Name: 

      Address: 

         City: 

        State:    Zip: 

        Phone: 

Date of Birth:    Age on race date: 

       Gender: M F

   Shirt Size: SM L XL

        Event: Runner Volunteer

    Entry Fee: $13 Race Day: $15

    

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 participate in this race, including but not limited to, falls, contact with other participants, the effect of the weather, including high heat and humidity, and the conditions of the path or road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your acceptance of my enrolment, I , for myself and anyone entitled to act on my behave, waive and release the Prince Georges Running Club, its agent representatives, and the race officials, their representative and successors, the Road Runners Clubs of America, the NMCPPC, the 94th Aeroquadron, Ballys Total Fitness and all others, from all claims or liabilities of any kind arising out of my participation in this event.

_______________________________  _____________ _____________________________________

Signature                        Date          Parent's Signature if under 18

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