Entry Form SFD Road Race

May 11, 2008

Name:_____________________________

Age (Day of race)_____________

Address:____________________________

City:_______________________________

State:____    Zip:____________

Telephone  #:_______________________

Sex: Male___   Female____

Division (check one only) __17under    __    18-29  __30-39    __    Firefighter      __  40-49      __   50-59     __Over 60  

Category (Please check which race you would like to enter)

5k Road Race_____ $18.00               1K + Road Race____$10reg  /  $18with T-Shirt                    Walk______ $10reg  /  18with T-Shirt

Only First 250 pre Registered 5K runners will receive a T-shirt                T-Shirt size (circle one) Large      XL Large

Release:

Release: I herby for myself, my heirs, executors, and administrators waive any and all rights and claims for damages I have against the race directors, The Scituate Fire Fighters Local 1464, their successors and assigns, for any and all injuries by me at said benefit road race and walk.

Signature______________________________                          Date_______________________________

(parent or guardian if under 18)

No need to print below the line

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                            Mail application to :      Scituate Fire Fighters    (Due by: 5/8/08)

                            Benefit Road Race

                     c/o Brian McGowan

                   PO Box 254

                                Scituate, MA 02066

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