REGISTRATION FORM

BERLIN PARADE 5K

JULY 4, 2006

Name ____________________________________________________________

Address __________________________________________________________

City ________________________________ State ______ Zip _______________

Age on 7/4/06 __________ Sex _________

Telephone _________________ Shirt Size: M ___ L____ XL ____

T-shirts to first 200 entrants

RELEASE

I, the undersigned acknowledge that a road race is a potentially hazardous activity. I certify that I am mediacally able and have sufficently trained for this event. I agree to abide by all decisions of the race as final. In consideration of the acceptance of my entry and intending to be legally bound, i do hereby for myself, and anyone entitled to act on my behalf, waive, release, and discharge The Inter-Community Celebration Association, its officers, employees, and the borough of Berlin/Berlin Twp., and all other sponsors and participants from any and all liabilities arising out of my participation in this event.

____________________________________________________________

Signature of Adult or Parent if racer is under 18