Race Date:  September 29, 2007, 8:30am

Registration Fee:  $17.00 (must be postmarked by 9/24/07), $20.00 day of race

 

Please print:

Name:     _______________________        Sex:  M   F       Age on race day:  ________

Address:

________________________(street), ____________________________(city), _______ (state) ____________(zip)

Phone:     ___________(area code) _______________________

Email:     ________________________________________

 

 

 

 

Team Division (minimum 3 Member Teams):

Team Name:  ______________________   Circle one (optional):    Corporate     Club     

School              ___________________________________

 

Tshirt size:    S       M       L       XL

 

Timing will be from the start signal to the finish chip mats, i.e., gun times only.

If using your own Championchip®, please enter chip number here:  __ __ __ __ __ __ __

 

Non-chip owners:  Championchips® will be supplied in race packet at race registration.  Chips must be returned after the race or a $35.00 charge will be imposed.

 

 

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 event.  I assume all risks associated with running or walking this event including, but not limited to falls, contact with other participants, the effects of the weather, including high heat/humidity/cold, traffic and conditions 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 the Town of Eliot,  Eliot Festival Day Committee, Eliot United Methodist Church, Eliot 5k Road Race Committee, Road Race Directors, Volunteers, and all Sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may rise out of negligence or carelessness on the part of the persons named in this waiver.  Further, I hereby grant full permission of any of the foregoing to use any photos, videotapes or any record of this event for any legitimate purpose.  I also agree to not participate in the race with a baby jogger, baby stroller, rollerblades or a pet.

 

Signature:    _______________________________________

Signature of Parent or Guardian if under 18:  ________________________________________

 

Make checks payable to Eliot 5k Road Race.

 

Send this Registration Form and $17.00 race entry fee (must be postmarked by 9/24/07) to:

            

             Eliot 5k Road Race

             P.O. Box 521                                                                   

             Eliot, Maine 03903

 

Please plan to arrive early!  You must be parked in the parking area by 8:00am. 

For questions contact:  eliot5k@hotmail.com