North Brunswick 5k

May 10, 2008 -- 5K, 8:00am; North Brunswick NJ, 08902

Name:
Last:                                                                     First:

Date of Birth:                           Sex:      M     F                   Age on 5/31/08:

Address:

City, State, Zip:

Shirt Size:          Adult --     S     M      L      XL      XXL(+$2)         Youth --     S    M      L 

Division:          5K Run/Walk           1K Fun Run 

Phone:                                        Email:

Team Name (if applicable):                                              Captain:

Release:
I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and run in this race unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. I assume all risks associated with running and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the North Brunswick 5k, Double Coverage, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or club activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver.  I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose.

Signature:                                                                                                          Date:

Parent Signature if under 18 years:                                                                   Date:

Form of payment (Circle One):     Check     Visa     Mastercard

Credit Card Number:                                                Exp. Date:


Make checks payable to Double Coverage:
33 Rachel Ct. Franklin Park, NJ, 08823


Fees:
$15 per person Teams of 5 or more (mail together, due by 4/15/08)
$20 individual pre-registration by 4/15/08
$25 everyone after 5/3/08 and race day registration

For information, call 732 322 3586 email johnporter78@yahoo.com