Trail of Two Cities

OFFICIAL ENTRY FORM

FIRST NAME _________________________________________________________

LAST NAME __________________________________________________________

ADDRESS ____________________________________________________________

CITY __________________________________ STATE _______  ZIP ____________

SEX _______     AGE ON RACE DAY _____

EMAIL _______________________________________

TELEPHONE __________________________________

WAIVER

ALL ENTRANTS MUST SIGN! In consideration for accepting this entry, and the granting of the right to participate in this event, I, the undersigned, intending to be legally bound, hereby, for myself, my heirs, personal representative, successors, and assignees, waive and release any and all claims for losses and damages I may have against Shore Memorial Hospital, the towns of Ocean City & Somers Point, partners, officers, directors, and employees, L & M Sports, all representatives, successors, and assignee and/or any other person whomsoever for any and all injuries, illness, including death, that may results from my participation in said event. I represent and affirm that I am in proper physical condition to participate in this event, and have sufficiently trained for the completion of this event.

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signature                                                                                                            date

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parental consent & signature required for all under age 18