COLLINGSWOOD MUSIC FESTIVAL 5K REGISTRATION FORM

Friday, Sept. 21, 2007

Deadline for Pre-registration: must be mailed by Saturday, Sept. 15, 2007 (please do not mail in applications race week)

Make checks payable to: Borough of Collingswood

Send to: L & M Computer Sports
     89 Park Drive
     Berlin, NJ   08009

Questions: (856) 858-1000 (Jerry)

FIRST NAME _______________________________    LAST NAME _____________________________________

ADDRESS _______________________________________________ TELEPHONE _________________________

CITY ______________________________________ STATE ______ ZIP CODE _________________

SEX ________  AGE _________   

I acknowlege that a road race is an extreme test of a person's mental limits and carries with it the protential for death, serious injury, and property loss. I hereby assume the risks of participating in these events put on by Collingswood Business Professional Asociation. I certify that I am physically fit, having sufficiently trained for participation in these events, and have not been advised otherwise by a qualified medical physician. I acknowlege that my statements on this application are being accepted by Collingswood Business & Profession Association in consideration for allowing me to become a participant in my selectec event(s), and being relied upon by these groups and various race sponsors, organizers, volunteers, timers, and administrators in permitting me to participate in any race of my choice.
In consideration for allowing me to become a participant in my selected competitive event(s) and allowing me to participate in these event(s), I hereby take the following actions for myself, my executors, administrators, heirs, next of kin, successors and assigns: A) I agree to abide bt the competitive rules adopted by event organizers, included the medical control rules, as they may be amended from time to time. And I acknowledge that my participation may be revoked or suspended for violation of the competitive rules: B) I waive and discharge from any and all claims or liabilities for death, personal injury, property damage, theft, or damages of any kind, which arise out of or relate to my particioation in, or my traveling yo or from said event the following persons or entities: event sponsors, race directors, event producers, volunteers, timers, all states, cities or localities in which events orsegments of events are held, and the officers, directors, employees, representatives and agents of any of the above: C) I agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein: D) I indemmify and hold harmless the persons or rntities mentioned above from any claims or liabilities assessed against them as result of my actions during an event(s) of my choice as selected on this application.
 
Signature ______________________________________________ Date __________________________________