Racing for a Reason

2003 St. Paddy's Day 5K Race

Race Application

Name __________________________________________________

Age _______ Gender: male female

Weight ________

Address ____________________________________

City ______________________ State _____ Zip Code ___________

Phone __________________________________

How will you compete: Age Group ___ Weight Group ____ Walker ______

Weight Class: (circle one )

Men 190-209 210-229 230+

Women 140-159 160+

Shirt Size: M L XL

Release: In consideration of the acceptance of my entry, I, myself, my personal representatives ans assigns do hereby release and discharge the Alzheimer's Association and sponsors, of all liability, claims, damage, demands, actions and cause of action whatsoever in any manner arising out of my participation in said athletic event, I attest and verify that I have full knowledge of the risk involved in this event, that I am physically fit and sufficiently trained to participate in this event, and that I understand that by signing this release I am giving up substantial legal rights, including the right to sue the parties stated above for any and all injuries or damages which I may incur during or as a result of this event.

I grant full permission for organizers to use photographs of me and quotations from me in legitimate accounts and promotions of this event.

___________________________________________ _____________

Signature Date

Parent if under 18n years of age